Research on the Hospital Construction and Structure in Daehan Empire and Colonial Modern Period / 의사학

It was the late Chosun Dynasty and Daehan Empire era that Western Medicine has firstly been introduced to Korea, previously operating on a basis of Korean traditional medicine. Western Medicine has been introduced by American missionary and Japanese Imperialism. An introduction of Western Medicine made it feasible to proceed new type medical care including operation, leading to require a new form of medical facilities. In the beginning, new facilities were constructed by Japanese Imperialism. Other hand many of facilities including Severance Hospital were established by missionaries. First of all, Daehan Empire established and managed a modern type of medical facility named "Jejoongwon" in 1885 as a government institution hospital. The Red Cross Hospital built in 1889. Afterwards, Jejoongwon and the Red Cross Hospital were taken over to missionary hospital and Japanese Imperialism, respectively. Japanese Imperialists firstly have protected their nationals residing in Chosun but have proceeded care a few Chosun people to exploit medical treatment as a mean to advertise superiority of the Empire of Japan. The facility that has firstly been established and managed was Jeseang Hospital in Busan in 1877, leading to establish in Wonju, Wonsan, and Mokpo. Afterwards, Japan has organized "Donginhoi" as a civil invasion organization, leading for "Donginhoi" to established "Dongin Hospital" in Pyeongyang, Daegu, and Seoul. Since 1909, governmental leading medical facility named Jahye Hospital was established according to an imperial order, leading to establish 32 hospitals all over the nation. American missionaries have established and managed 28 hospitals started from Severance Hospital built in 1904. However, Chosun doctors started to having educated and opening up their own hospital since 1920, leading for many of medical facilities to be established, but most of them have taken different roles followed by 6.25 War and economic development period. However, some of them are currently under protection as cultural assets, and some of them are now preserved. Buildings have originally been structured of wood as a single story in the beginning, but bricks started to be steadily used, leading to build two story building. Each of clinic department started to be separated since 1920, establishing operation room and treatment room. Now, a change of perception as to buildings that need to be preserved and an attention from government and doctors are required since modern medical facilities keep disappearing.

Ultrasonographic Bladder Parameters for Successful Suprapubic Bladder Aspiration / 소아과

PURPOSE: Suprapubic bladder aspiration(SBA) is a widely accepted method of obtaining sterile urine for culture in neonates but has a relatively low success rate and a few serious complications during SBA procedure. To improve the chance of obtaining urine, we determined the ultrasonographic bladder parameters(diameters and volume) to confirm that the bladder is adequately distended for successful aspiration of urine. METHODS: In 94 newborn infants who required sterile collection of urine, ultrasonographic examination and SBA procedure were carried out. On the patient's suprapubic area, the maximal cephalocaudal and anteroposterior diameters were measured by sagittal scanning, and the maximal anteroposterior and transverse diameters by transverse scanning. Bladder volume was calculated using the formula for elliptic volume, and then urine was aspirated to maximum of 10 mL and the amount of urine aspirated was recorded. RESULTS: Sufficient urine for culture(>1 mL) was obtained by SBA in 86(91.5%) of 94 infants. In the sagittal view, when the cephalocaudal diameter of the bladder was greater than 20 mm and the anteroposterior diameter was greater than 15 mm, the success rate was 100%. The cephalocaudal diameter of the bladder in sagittal view showed a more significant positive correlation with aspirated urine amount(r=0.65, P<0.001). CONCLUSION: The ultrasonographic sagittal view improved the success rate of SBA in neonates. A SBA was more likely to be successful when the cephalocaudal diameter of the bladder was above 20 mm and the anteroposterior diameter was above 15 mm.

The Critical Text from Boramae's Medical Dispute

No abstract available.

The Critical Text from Boramae's Medical Dispute

No abstract available.

Some Future-oriented Roles and Phases for the Ethics Committee of KMA

No abstract available.

Changes in Pulmonary Interleukin-6 and Pulmonary Pathology in Neonatal Mice After Exposure to Hyperoxia and Ascorbate Treatment

PURPOSE: Levels of proinflammatory cytokines such as IL-1, IL-6 and TNF-alpha have been shown to be increased in the lung of adult mice after exposure to hyperoxia. Ascorbate, a non-enzymatic antioxidant, might have a protective effect against oxygen-induced lung injury. We examined effects of hyperoxia and ascorbate treatment on pulmonary IL-6 levels and pathology in the lungs of newborn mice. METHODS: Neonatal mice were exposed to hyperoxia (95% O2) or room air (control) for 24 h or 48 h. Other groups, exposed to hyperoxia for up to 48 h, were injected intraperitoneally preventive doses (0.1 mg/10 g mouse weight) or therapeutic doses (1 mg/10 g mouse weight) of ascorbate or distilled water (placebo control) twice, immediately before and at 24 h of exposure to hyperoxia. IL-6 concentrations in the supernatant of minced lungs were measured by ELISA. RESULTS: There were no pathologic changes in the lungs except mild emphysema and alveolar hemorrhage. The median pulmonary IL-6 concentration was significantly higher in mice exposed to hyperoxia for 24 h (P<0.05) and for 48 h (P<0.001) than room air controls. There was no difference in pulmonary IL-6 concentration between hyperoxia-exposed (48 h) mice treated with either preventive or therapeutic doses of ascorbate and placebo controls. CONCLUSION: Neonatal mice exposed to hyperoxia for 24 h and 48 h showed higher pulmonary IL-6 concentrations than room air controls. Preventive or therapeutic doses of ascorbate had no effect on pulmonary IL-6 concentrations nor pulmonary pathology of neonatal mice exposed to hyperoxia for 48 h.

A Case of Hemolytic Disease in the Newborn Due to Anti-Dia Antibody

The Diego blood group is expressed as Dia antigen and Dib antigen. The frequency of Dia antigen expression in Korean is estimated to be 6-15%. We report the first case of severe hemolytic disease caused by anti-Dia antibody in Korea. Full-term male infant was admitted due to hyperbilirubinemia on the first day of life. Total bilirubin level was elevated to 20 mg/dL at 20 hours of age and exchange transfusion was performed. Total bilirubin decreased to 12.7 mg/dL after exchange transfusion, but increased to 19.0 mg/ dL at 43 hours of age. After second exchange transfusion, total bilirubin was 6.0 mg/dL. The blood group of mother was type A, Rh D (+ and that of newborn was type O, Rh D (+. The direct antiglobulin test showed strong positive, and anti-Dia antibody was eluted from the baby's red blood cell. Due to higher incidence of Dia antigen expression in oriental population, we suggest that the Diego positive cell panel should be included in the diagnosis of hemolytic disease of the newborn.

Effect of Maturation on Endothelium-Dependent Relaxation in Pulmonary Arteries of the Newborn Rabbit

PURPOSE: This study was done to determine whether maturatin alters endothelium- dependent responses in pulmonary arteries. METHODS: Vascular rings of pulmonary arteries, with and without endothelium, taken from rabbits of 3 and 30 days of age were suspended in organ chambers filled with Krebs-Henseleit solution, bubbled with 95% O2-5% CO2 and maintained at 37degrees C. Immediately after mounting, the rings were stretched progressively until a maximal response to KCl was achieved. The rings were incubated with indomethacin and allowed to equilibrate before contraction and relaxation study. RESULTS: When the endothelium was intact in arterial rings from 3-day-old rabbits, acetylcholine (ACH) (10-6 M) relaxed preconstricted rings with histamine (5x10-6 M) (98.1 4.7% relaxation, mean SD). In rings without endothelium, KCl (10-2 to 9x10-2 M) and histamine (5x10-8 to 10-5 M) caused concentration-dependent contractions. When normalized to maximal contractions achieved to each agonist, the concentration-effect curves to KCl and histamine in rings without endothelium were similar to both ages. Rings with endothelium showed a progressive shift to the right of the concentration- effect curve to histamine. Relaxation to sodium nitroprusside were unaffected by age. In preconstricted ring, ACH (10-8 to 5x10-6 M) caused relaxations in rings with endothelium which were greater at 30-day compared to 3-day-old rabbits. CONCLUSION: These study demonstrates that endothelium-dependent relaxation increase with age, possibly due to changes in the release and/or effect of endothelium-derived relaxing factor (EDRF or nitric oxide) from pulmonary arteries during the neonatal period.

Effect of 21-aminosteroid U74389G on the Extent of Brain Damage and Edema in the Newborn Rats with Hypoxic-ischemic Injury

PURPOSE: To investigate the effect of 21-aminosteroid U74389G (U) on the extent of brain damage and edema formation in the newborn rats with hypoxic ischemic (HI) brain injury. METHODS: This is a randomized, placebo-controlled, experimental study. The subjects were 113 seven-days-old rats with HI injury. Pups were treated with 3, 10, or 20 mg/ kg of U intraperitoneally 30 minutes before hypoxia (Group 1, 2, 3: n=10, 13, 11), 10 mg/kg of U immediately after hypoxia (n=11) (Group 4), 10 mg/kg of U 30 minutes before and after hypoxia (n=n=13) (Group 5), or vehicle (n=12) (Group C). We expressed the degree of brain infarction and brain edema in % atrophy (Left hemisphere-Right hemisphere/Left hemispherex100) and water content % (wet weight-dry weight/wet weightx100) RESULTS: There were significant reductions in the diameters of right hemisphere compared with those of left hemisphere in vehicle and U treated animals (P<0.05). As to the cortical thickness, group 2, 3 and 5 pups showed no significant reductions in the right side compared with the left side implicating that U treatment in these groups was of benefit in attenuating HI cortical injury, while there was significant difference between the right and left side in group 1, 4 and C animals (P<0.001). There was a significant difference (P< 0.01) in % atrophy of group 2, 3, 5 versus group C, but the mean % atrophy was similar in groups 1, 4 and C. There was a significant (P<0.05) increase of water content in right hemisphere compared with left hemisphere both in U and vehicle treated groups. CONCLUSION: Pre-treatment and prepost-treatment at moderate doses (10 or more mg/kg) of 21-aminosteroid U74389G reduced the extent of perinatal hypoxic-ischemic brain damages, especially in the cortex, but do not affect the extent of brain edema.

Prospective evaluation of perinatal risk factors for cerebral palsy and delayed development in high risk infants

Prematurity, intrauterine infection and perinatal brain injury have been reported to be significant risk factors of cerebral palsy (CP). We examined the perinatal predictors of cerebral palsy and delayed development (DD) in 184 high risk infants. Thirty-five infants were diagnosed as cerebral palsy and delayed development at 12 months corrected age. Antenatal, intrapartum, and neonatal factors were prospectively evaluated in 2 groups of high risk infants compared with controls; Group A (n = 79), infants weighing less than 2,000 g; Group B (n = 43), infants weighing 2,000 g or more. In univariate analysis, there were no significant antenatal and intrapartum factors associated with cerebral palsy and delayed development in either group. We found that significant postnatal risk factors of CP in group A included sepsis (p = 0.008), BPD (bronchopulmonary dysplasia) (p = 0.028), IVH (intraventricular hemorrhage) (p = 0.042), ventriculomegaly (VM) (p = 0.001) and a longer duration of mechanical ventilation (p = 0.001); while in group B, sepsis (p = 0.047) and neonatal seizure (p = 0.027) were significant risk factors. In multivariate analysis, sepsis in group B was a moderate risk factor of CP (OR (odds ratio) 1.47; 95% CI (confidence interval) 1.02-2.13). In conclusion, neonatal sepsis may contribute to the development of cerebral palsy and delayed development. We suggest that high risk infants who have sepsis should be carefully followed for cerebral palsy and delayed development. The prevention of cerebral palsy may be feasible by decreasing neonatal risk factors such as sepsis during the neonatal period.

Clinical Trial of Domestically Developed Bovine Lung Surfactant YY-38 in Neonatal Respiratory Distress Syndrome

PURPOSE: We previously reported modified bovine lung surfactant YY-38(Newfactan ) had a low surface tension, good hysteresis, and exhibited good pressure-volume curve in animal experiment(J Korean Pediatr Asso 1997;40:771-85). We performed multicenter clinical trial of Newfactan in neonatal RDS. METHODS: Seventy-seven infants with RDS(GA 31.8+/-2.9 wks and BW 1,809+/-592 gm) in 4 NICU were enrolled. After administration of Newfactan , we analyzed ventilator parameters and outcomes in 71 infants excluding mortality cases(n=6), and also compared risk factors between response(n=53) and redosing group(n=18). RESULTS: Newfactan was administered at 6.8+/-7.2 hr after birth. Ventilator parameters such as FiO2, alveolar-arterial oxygen difference(a-A PO2) and oxygenation index(OI) except mean airway pressure(MAP) were significantly improved from six hours after administration. All parameters were improved at 24 hours after administration and persisted for 5 days. Outcomes were as follows; PDA(n=24), BPD(n=16), IVH(n=13), sepsis(n=9), ROP(n=7), pneumothorax(n=4) NEC(n=3), PIE(n=2), and pulmonary hemorrhage(n=1). All patients survived 30 days after birth. Redosing rate was 25%. The incidence of PDA was greater in redosing(56%) than in response group(26 %)(P=0.025). CONCLUSION: In prospective multicenter clinical trial, Newfactan was effective in the treatmentof RDS.

Double-blind Randomized Dose Controlled Multicenter Study on Prevention of Anemia in VLBW Premature Infants Treated with High Dose rhEPO (recombinant human erythropoietin)

PURPOSE: Very low birth weight infants frequently suffer severe anemia. This study was designed to evaluate the effectiveness of rhEPO for prevention of anemia of prematurity and for reduction of the need for transfusion in very low birth weight infants. METHODS: Eighty very low birth weight infants(<1.5 kg) whose gestational age was under 33 weeks were enrolled at 9 university hospital in Korea. This study was conducted as a double-blind randomized, dose-controlled study. In high dose EPO group, 500 IU/kg of rhEPO was subcutaneously administered every other day for 17 times. In low dose EPO group, 250 IU/kg of rhEPO was subcutaneously administered every other day for 17 times. In control group, placebo was administered in the same manner. The effectiveness of rhEPO was evaluated for multiple parameters. RESULTS: 1) Infants receiving high dose rhEPO showed a significant increase in hemoglobin and hematocrit by 3 weeks(P<0.05). 2) Infants receiving high & low dose rhEPO showed an increase in reticulocyte count by 1 week(P<0.05). 3) There were no significant changes in platelet, WBC count, and ANC in each group. 4) Serum concentration of erythropoietin, iron, TIBC and ferritin were highly variable in study patients.5) Incidence of anemia k transfusion in high dose rhEPO group was lower than low dose and control group(P<0.05). 6) Number of patients who did not receive transfusion and whose hematocrit did not fall below 30% in high dose rhEPO group was significantly higher than in low dose and control group(P<0.01). CONCLUSION: High dose recombinant human erythropoietin(rhEPO) treatment for anemia of prematurity may minimize the decrease in hemoglobin and hematocrit, rapidly increase reticulocyte count and reduce the need for transfusion.

Increase in IL-6 and Number of Inflammatory Cells in the Lung Lavage Fluid of Adult Mice Exposed to 95% Oxygen: Protective Effect of Budesonide

PURPOSE: Pulmonary oxygen toxicity is mainly an inflammatory process, triggered by reactive oxygen species via a number of biochemical pathways. Recent evidence implies that ROS may stimulate NF-Kb to promote the synthesis of genes for inflammatory cytokines. At the same time, corticosteroids have been implicated in the prevention of activating this step. However, adverse reactions of systernic corticosteroids cause physicians to hesitate their use, not to mention their doubtful effectiveness. Budesonide is a locally acting corticosteroid with little systemic effect. Inhaled either through nebulizers or metered dose inhalers, it has proved the antiinflammatory, and thus antiasthmatic, effects in patients with asthma. If oxygen-induced injury is mediated by factors involved in a similar pathway as described above, budesonide will have protective effects against inflammatory responses of pulmonary oxygen toxicity. METHODS: We used 10 adult mice in each of the three groups, AC is the room air control group, OC is the oxygen control group in which mice were exposed to 95% oxygen for 48 h; and TX is the treatment group in which mice were exposed to 95% oxygen for 48 h, and during that period they were given budesonide via a nebulizer 500 p g/dose every 12 h for 4 times. The mice were sacrificed with iection of a lethal dose of ketamine. Tracheotomy was done and an 18G ET tube was inserted. The lungs were lavaged with 80 ml/kg(or 80 microliter/g) isotonic saline slowly injected through the ET tube. The lung lavage fluid was centrifuged at 8000 rpm for 2 rninutes. Supernatant was used for analysis of IL-6, while the precipitate was resuspended in 200 microliter of isotonic saline for cell count. RESULTS: The simple mean IL-6 values did not show a significant difference between groups (AC 199.4+/-192.7; OC 274.5+/-31.3; and TX 269.8+/-127.G pg/Ml). But considering their skewed distribution in AC and TX groups, the median values showed a conspicuous difference among 3 groups, that is, the median IL-6 value of AC was 124.8 pg/Ml, OC 269.8 pg/Ml, and TX 217.4 pglmL. For the cell counts, AC was 189+/-56/mm, OC 424+/-111/mm, and TX 266+/-22/mm(P<0.05). CONCLUSION: In conclusion, budesonide nebulization appears to have protective effects against inflammatory responses of pulmonary oxygen toxicity in adult mice.

A Case of Congenital Tuberculosis

Perinatal tuberculosis can be divided into congenital tuberculosis due to intrauterine infection and neonatal tuberculosis due to infection irnmediately following birth. It is a rare disease entity with only 300 cases reported worldwide. In Korea, only a few cases have been reported and only 1 case has been confirmed by autopsy at neonatal period. Although the majority of the mothers are found to have advanced tuberculosis and the children themselves are usually of premature birth, early diagnosis is difficult and despite antituberculous medication, the mortality rate is high. We report a premature baby with respiratory difficulty admitted to our hospital, whose mother was found to have miliary tuberculosis during the course of management. The baby died and autopsy was performed to confirm congenital tuberculosis.

Effects of Hydrogen Peroxide and Catalase on Physical Properties of Surfactant

PURPOSE: In the treatrnent of respiratory distress syndrome, Infants are often exposed to hyperoxia. It can generate oxygen free radical, damage to lung and bronchi, and inactivate pulmonary surfactant(PS). Antioxidant therapy in animal and human models has been tried to overcome this detrimental effects. We hypothesized that the addition of oxygen free radical such as hydrogen peroxide(H) could compromise surface active properties(SAP) of PS and that further addition of antioxidant such as catalaseR(CAT, Sigma chemical, St. Louis) could recover SAP. METHODS: We prepared combinations of mixtures with SurfactenR(S-TA, Tokyo Tanabe, Japan), H202 and CAT. 1)0.625mgPL(phospholipids)/ml or 1.25mgPL/ml S - TA and H202 were mixed to the final concentrations of 0.1 and 1mM H respectively, and incubated at 37C for one hour. 2) 0.625mgPL/rnl S - TA, H202 and CAT 10U were mixed to the final concentrations of lmM H202, and incubated at 37 degree C for one hour. We used Pulsating Bubble Surfactometer (Electronetics, NY) measure in vitro minimum and maximum surface tensions(ST) and area-surface tension relationship. RESULTS: 1) For 0.625mgPL/ml S-TA and 1mM H mixture minimum. ST after 5 min of pulsation increased significantly(P=0.007) and the area-surface tension curve was deformed. But they were comparable to control levels for 1.25mgPL/ml S-TA. 2) When CAT was added to 0.625mgPL/ml S-TA and 1mM H mixture, the resultant minimum ST after 5 min of pulsation dropped to the control levels with recovery of hysteresis curve(P=0.0001). CONCLUSION: PS could be inactivated by addition of high concentrations of H but SAP can be recovered either by increasing PS concentration or by further addition of antioxidant CAT. Therefore, we suggest that in case of suspected surfactant inactivation an increase in surfactant concentration or administration of antioxidant must be considered.

Effect of Antenatal Steroid on fluid Balance and Clinical Outcome in Bery Low Birth Weight Infants Rceiving REstricted Fluid Regimen / 대한주산의학회잡지

PURPOSE: Antenatal steroid(ANS) therapy in premature infants is an effective therapeutic strategy in reducing the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and patent ductus arteriosus. For premature infants to gain improved survival, adequate weight loss during early postnatal days and maintenance of electrolyte balance is important, however, it is uncertain that ANS affect them. We hypothesized that ANS augment fluid and electrolyte balance and dinical outcome of very low birth weight(VLBW) who had received restricted fluid regimen. METHODS: Mechanically ventilated VLBW infants who survived over 30 days were selected. We reviewed medical records to compare weight loss, urine output, electrolyte concentration, blood pressure during five days of life and clinical outcome between premature infants who received ANS(n=15) and who were not(n=58). RESULTS: Gestational age, birth weight were similar between two groups. Volume of administered fluid, urine output, and initial weight loss during first five days of life were similar, however, weight loss on postnatal day five were lower in study group than control group(p=.039). Blood pressure, serum sodium concentration, serum potassium concentration, and urine specific gravity were similar between two groups. Incidence of respiratory distress syndrome was lower in study group(20%) than control group(48%)(p=.041), however, incidence of sepsis were greater in study group(33%) than control group(7%)(p=.029). CONDUSION: ANS did not affect fluid and electrolyte balance of very low birth weight(VLBW) infants who had received restricted fluid regimen. ANS decreased the incidence of respiratory distress syndrome in this population, however, increased the incidence of sepsis.

Seasonal or Gender Effects on Cord Serum Insulin-like Growth factor-I Concentrations in Newborn Infants / 대한주산의학회잡지

Possible seasonal differences in serum Insulin-Like Growth Factor-I (IGF-I) concentrations have not been studied in newborn infants. Recently we demonstrated sea- sonal differences in bone mineral content (BMC) in newborn infants: lower BMC was present in summer vs. winter-born infants (J Pediatr Gastroenterol Nutr 1992; 15: 285). In a second stduy, higher serum osteocalcin, an index of bone formation, and lower BMC were found in summer vs. winter (J Pediatr Gastroenterol Nutr 1994; 19: 2207). We speculated that increased serum osteocalcin in summer could be an adaptive response to decreased bone mass. Since growth factors such as IGFs are local regulators of bone formation, we hypothesized that in summer-born infants, serum IGF-I will be higher than in winter, associated with high bone formation activity. Fifty-nine healthy, term appropriate for gestational age (AGA) infants were studied prospectively in winter (Jan-Mar, 29) and in summer (July-Sept., 30). Thirty infants were male, and 29 infants were female. Gestational ages and birth weights were not different by season(in summer, mean+SD, 39.61.1 wk, 3,471360 g,' in winter, 39.31.4 wk, 3,402 392 g). Cord serum IGF-I was measured by radioimmunoassay, modified from Furlanetto et al (1977), after acidification and sep-pack extraction of serum, and osteocalcin concentrations were determined by a kit radio-immunoassay. Cord serum IGF-I concentrations were not different by season of birth(summer vs. winter, 20.11.83 vs. 16.5 1.75 ng/mL, p=0.2). No gender differences were found: 18.21.8 vs. 18.2+1.8 ng/ mL in males vs. females. Serum osteocalcin was higher in summer vs. winter-born infants (8.22.3 vs. 4.951.58 ng/mL, p=0.009). BMC was different by season (87.2+ 14.5 vs. 94.1+16.4 mg/cm, p=0.02). Cord serum IGF-I was not related to serum osteocalcin and BMC. We conclude that serum IGF-I concentrations are not different by season or gender, and are not related to bone formation activity and BMC. Thus, IGF -I concentrations in serum are not seasonally regulated, nor associated with an index of bone formation activity.

Physical and Biological Activity of Domestic Product of Modified Bovine Lung Surfactant

PURPOSE: Neonatal respiratory distress syndrome is caused by the deficiency of lung surfactant in premature babies. For the treatment of RDS at present surfactants such as Surfacten (Tokyo-Tanabe Co., Japan) and Exosurf (Wellcome Co., USA) are used. As awarded the grant from the Ministry of Science and Technology for a model research project of Medium-Technology program, we have modified (supplemented) the bovine lung extracts to get YY-38, for which we have performed physical and biological activities. METHODS: For physical properties, we performed stable microbubble test (SMR) and measured surface tension lowering activity using a pulsating bubble surfactometer. Minimum and maximum surface tensions measured at 1 and 5 minutes gave surface tension-surface area diagrams, from which compressibility at surface tension 10mN/m was also calculated. As to the biological activity, we used premature rabbit fetuses as a model for the study of pressure-lung volume relationship. The lung pathology was examined on the lung tissues subsequently obtained, and aerated area ratios were calculated based on the area measured by an image analyzer. RESULTS: The minimum surface tensions of YY-38 at 1 and 5 minutes for all different concentrations were low at 10mN/m, while the maximum surface tensions ranged from 33.01mN/m to 41.07mN/m. The surface tension-surface area curve showed a definite hysteresis at 1 and 5 minutes for all concentrations, and the surface tension fell below 10mN/m with 20% surface area compression. The compressibilities at surface tension 10mN/m at 5minutes for all concentrations were all below 0.02. In animal experiments, the mean lung volume of premature rabbit fetuses was inflated to 80.9ml/kg at maximum 30cmH2O, while the lung volume was maintained at 38.3mg/kg when the lung was deflated to 5cmH2O. The overall aerated area ratio was 45.4%. CONCLUSIONS: YY-38 formed sufficient amount of stable microbubbles and had a surface tension low enough to maintain alveolar stability and to exhibit a good hysteresis curve. In animal experiments it helped the expansion of premature lungs during inspiratory phase and was effective in the prevention of collapse during expiratory phase.

Risk factors for Pulmonary Interstitial Emphysema (PIE) in Mechanically Ventilated Neonates with Hyaline Membrane Disease

PURPOSE: Pulmonary interstitial emphysema (PIE) is a common and serious complication of mechanical ventilation in infants with hyaline membrane disease. This abnormal collection of gases has two basic roentgenographic features; linear and cyst-like radiolucencies. High positive inspiratory pressure was found to be the most significant parameter associated with development of fatal pulmonary interstitial emphysema. Without prompt conservative management such as lowering peak inspiratory pressure, PIE often progress to a pneumothorax with increased mortality. We studied the incidence and risk factors of PIE and associated risk factors which progress to pneumothorax in mechanically ventilated infants with hyaline membrane disease. METHODS: We reviewed retrospectively the charts of infants who had been admitted to the neonatal intensive care unit between Jan. 1990 and Mar. 1995. A hundred and two infants who were diagnosed as hyaline membrane disease and mechanically ventilated were included in the study. Analysis of clinical characteristics and ventilator parameters were made. Chest radiographs were reviewed for hyaline membrane disease, PIE, pneumothorax by a pediatric radiologist without knowledge of their clinical course. RESULTS: 1) We observed PIE in 14 of 102 infants (13.7%) of which 11 infants progressed to develop pneumothorax. 2) Low gestational age, low apgar score and high peak inspiratory pressure were the factors significantly associated with development of PIE. 3) PIE was frequently located bilaterally (52%), distributed on whole lung parenchyme (92%). Sizes of radiolucency were variable including blebs. 4) Early onset PIE and failure to promptly lower peak inspiratory pressure were the associated risk factors for development of pneumothorax. 5) Pneumothorax developed within a mean 7.5 hours after apperance of PIE. Right side pneumothorax was more frequent (67%). Mortality increased to 73% with development of pneumothorax in PIE. CONCLUSIONS: Early diagnosis of PIE and prompt lowering of peak inspiratory pressure should be emphasized to improve the survival and outcome of mechanically ventilated hyaline membrane diasease infants.

Neonatal Statistics of Korea in 1996: Collective Results of Live - Births , Neonatal Mortality , and Incidence of Dischage Against Medical Advice at 64 Hospitals

PURPOSE: To evaluate the nation-wide results of statistics related to the neonatal period of 1996, we collected data of a total of 64 hospitals in Korea (42 university hos- pitals and 22 general hospitals). METHODS: We obtained the results of 129,175 inboms and 9,379 outborns, and analyzed the statistics of live-births, ig, distribution of live-births by gestational age and birth weight, incidence of pre-term infants and low birth weight infants (LBWI), neonatal mortality, and incidence of discharge against medical advice (DAMA). RESULTS: According to birth weight, incidence of LBWI, normal birth weight, infant and high birth weight infants was 3.6%, 86.6% and 9.8%, respectively in the case of inborn group. But incidence of LBWI was higher in outborn group as compared with the inbom group. According to gestational age, incidence of preterm, term, and post-term was 11.1%, 87.1Yo and 1.8% respectively in the inbom group. The incidence of preterm in outborn group was higher than that of inborn group, because of the influnce of transpor- tation of high risk neonates to 2nd or 3rd levels of neonatal intensive care units (NICU). Overall neonatal mortality per 1,000 live-births was 9.3 in the inborn group amd 37.6% in the outborn group. These data revealed a high neonatal mortality, because the numbers of DAMA cases was also included. The incidence of DAMA was 0.44% and 1.15% in inborn and outborn groups, respectively. The percentage of the DAMA among the numbers of neonatal mortality was 47.2-48.8M in the inborn group. CONCLUSIONS: We obtained the statistics related to live-birth, incidence of prematurity and LBWI, neonatal mortality, and incidence of DAMA in Korea. The data revealed high levels of neonatal mortality (which included the sum of neonatal death and the number of DAMA) and incidence of DAMA in Korea at present. To achieve a low-level of neonatal mortality, more efforts to decrease the incidence of DAMA are needed. Also, a greater facility for NICU and a stronger support system from a nation-wide govemment policy and system of insurance are seen to be necessary.