Usefulness of Pasma Atrial Natriuretic Peptide Concentration in the Diagnosis of Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Diagnosis of a hemodynamically significant patent ductus arteriosus(PDA) that should be treated is difficult to determine by clinical and echocardiographic examinations. The aim of this study was to clarify the interrelationship of plasma atrial natriuretic peptide(ANP) concentrations and clinical signs or echocardiographic signs of PDA in preterm infants and use plasma ANP concentrations as a diagnostic indicator of a hemodynamically significant PDA. METHODS: Twenty-four preterm infants who were born at Guro Hospital, Korea Medical Center were evaluated on the 3rd day after birth. Clinical signs(cardiovascular dysfunction score 3) and echocardiographic signs[magnitude of left-to-right shunt across a PDA and left atrium(LA): Ao ratio] of a PDA and plasma ANP concentrations were measured. RESULTS: Plasma ANP concentrations and LA/Ao ratios of preterm infants with hemodynamically significant PDA were significantly higher than those of preterm infants without hemodynamically significant PDA. Plasma ANP concentrations were related to the magnitude of the left- to-right shunt across a PDA and LA: Ao ratio. Plasma ANP concentrations of LA/Ao of more than 1.3 were significantly higher than that of LA/Ao of less than 1.3. CONCLUSION: In preterm infants, high plasma ANP concentration may be a useful predictive indicator of a hemodynarnically significant PDA. Measurement of plasma ANP concentration may play a role in deciding the need for and timing of medical or surgical management of preterm infants with PDA.

Relation between Renal and Scrotal Involvememt in Henoch-Sch nlein Purpura

PURPOSE: Although Henoch-Sch nlein purpura(HSP) has been described in detail, there is a paucity of information describing scrotal involvement and risk factors for renal involvement. This study was performed to evaluate the incidence of scrotal involvement and the relationship between renal and nonrenal involvement, including scrotal involvement. METHODS: We retrospectively reviewed medical records of 164 male children who were diagnosed as HSP at the Department of Pediatrics, Korea University Guro Hospital between January 1985 and December 1997. RESULTS: The incidence of scrotal involvement was 13.4%(22/164), and the mean age of the group of scrotal involvement was significantly younger(5.6+/-1.9 year) than that of the others (P<0.05). One patient was initially seen with scrotal involvement without any other symptoms, another patient, who presented with acute scrotal pain and swelling, turned out to have testicular torsion through laparotomy. Those with scrotal and gastrointestinal symptoms were more likely to be related to renal involvement at acute stage, but there was no statistical difference. Those with scrotal symptoms at acute stage developed nephritis more frequently after 6 months(P<0.05). CONCLUSION: Those with scrotal symptoms at acute stage of HSP should be followed up for at least 6 months.

Plasma Atrial Natriuretic Peptide and Hemodynamic Change of Patent Ductus Arteriosus in Healthy Low Birth Weight Infants without Clinical Evidence of PDA

PURPOSE: Atrial natriuretic peptide(ANP) is a hormone with strong vasodilating, diu-retic and natriuretic properties. The aim of this study was to clarify the interrelationship of ANP secretion and hemodynamic changes of patent ductus arteriosus(PDA) in healthy preterm and fullterm infants without clinical evidence of PDA. METHODS: Thirteen preterm infants and six full term infants who did not develop clinical evidence of PDA were studied at 6 hr, 12 hr, 24 hr, 3rd day and 4th day after birth, until their PDAs closed spontaneously. Plasma ANP concentrations and the hemodynamic changes of PDA were rneasured. RESULTS: The ANP concentrations of all infants increased from 34.1+/-10.9 pg/ml at 6 hr to 120.5+/-18.8 pg/ml at 12 hr, and declined thereafter gradually to 74.2+/-12.7 pg/ml at 4th day. The ANP concentrations, LA/Ao ratio and LAV decreased after ductal closure. The pulmonary flow velocity(PFV) of PDA correlated with ANP concentration in preterm infants(r=0.23, P<0.05). LA/Ao ratio correlated with ANP contration in all infants (r=0.28, P<0.05), especially in preterm infants(r=0.46, P<0.01 during 12 hr and 4th day after birth. LAV correlated with the ANP concentrations in preterm infants during 12 hr and 4th day after birth(r=0.34, P<0.05). CONCLUSION: The changes of ANP concentrations are probably due to the changes of the left-to-right shunt of PDA with left atrial stretch. Reduction of the ANP concentrations may serve as an indicator of spontaneous closure of PDA. Therefore ANP measurement may be useful in deciding the need and the timing of medical and surgical managernent of newbom infants without clinical evidence of PDA.

A Case of Cutaneous Ossification occurring in Pseudohypoparathyroidism

In Albright's hereditary osteodystrophy (AHO) including the syndromes of pseudohypoparathyroidism (PHP) and pseudopseudohypoparathyroidism (PPHP), multiple areas of intracutaneous ossification are often encountered. The characteristic features are short stature, round face, short neck, obesity, cutaneous ossifications, and various skeletal anomalies including short metacarpal and metatarsal bones, curve of radius, and brachydactyly. The patient was a 10-month-old male infant. He presented slightly depressed erythematous hard plaques on the left upper chest and left thigh. We had taken biopsies from both skin lesions, confirming cutaneous ossification or bone formation. He also had the characteristic features of AHO. He had a history of admission due to patent ductus arteriosus and atrial septal defect. The laboratory results showed slightly decreased calcium, increased phosphorus and PTH levels. The patient received no specific corrective measures because his calcium and phosphorus levels were not far from normal values until newly developed similar skin lesions appeared.

Radiologic Localization and Lengths of Umbilical Artery Catheter to Major Aortic Branches Determined by Ultrasonography in Neonates

PURPOSE: Incorrect positioning of umbilical artery catheter (UAC) results in an increased incidence of complications and erroneous pressure measurements. We radiologically localized major aortic branches and calculated the length of catheter from umbilicus to celiac artery, renal artery and aortic bifurcation for optimal positioning of UAC. To determine the neonatal body measurement that best predicts optimal UAC lengths, we studied three commonly used parameters-birth weight (BW), total body length (TBL) and shoulder-umbilicus length (SUL). METHODS: Fifty one high type of UAC were routinely identified by sonographic scanning from the epigastrium in longitudinal projection and 42 low type of UAC from the flank in coronal projection. The distances from the catheter tip to the celiac artery, the renal artery and to the aortic bifurcation were measured by electronic calipers and were compared with the length of the catheter from umbilicus to the tip on the chest anteroposterior radiograph. RESULTS: The celiac arteries originated from T10-T12, renal arteries Ll-L2, and aortic bifurcations L3-L5. There was positive correlation between BW, TBL or SUL and the length of catheter to the celiac artery (r2=0.476, 0.749 or 0.753), to the renal artery (r2= 0.785, 0.847 or 0.720), and to the aortic bifurcation (r2=0.714, 0.809 or 0.747). CONCLUSION: Although any one of the three parameters can be used clinically, we prefer the TBL and SUL parameters for its reliability and usefulness in emergency settings. The use of a new distribution plot of origins of major branches and regression equations for calculation of the lengths may help deciding the optimal position of UAC.

Renal-specific Regulation of Apoptosis and It's Modulators by Angiotensin II / 대한신장학회잡지

Angiotensin II plays an important role in the regulation of systemic and renal hemodynamics, and functions as a growth factor in various tissues. To determine whether ANG II are related to renal-specific stimulation of apoptosis, 36 adult male Sprague-Dawley rats were infused with ANG II at 50 ng/min(low ANG group), 100 ng/min(high ANG group), or vehicle(control group) for 1 week using osmotic minipump(Model 1007D, Alza Co, USA) inserted into the interscapular area of the back. Blood pressure and serum aldosterone level were measured. To detect apoptosis of the kidney, TUNEL(Terminal deoxynucleotidyl Transferase dUTP Nick End Labelling) technique was introduced. Cellular proliferation was detected with PCNA immune histochemical staining. To know the expression of Bcl-2 protein and mRNA, immune histochemical staining, Western blot assay and RT-PCR were done. Results were as follows: 1) There were no differences in body weight or organ weight/body weight among 3 groups. 2) Mean blood pressure between control and low ANG group were not changed throughtout the study. But mean blood pressure was increased at th day 3 and 7 in high ANG group(P<0.05). Serum aldosterone level increased at the day 7 in high ANG group only(P<0.05). 3) PCNA positive cells were increased significantly in the the low ANG groups compared with the control group(P<0.05) and they were decreased significantly in the .high ANG group compared with the the low ANG group(P<0.05). However, they were not different between control and high ANG groups. 4) Apoptosis of renal medulla was increased significantly in the low and high ANG groups compared with the control group(P<0.05). 5) Expression of bcl-2 protein was decreased significantly in the low and high ANG groups compared with the control group(P<0.05). In this study, ANG II infusion induced renal apoptosis and changed expression of PCNA but decreased expression of bcl-2 in the kidney of the Sprague-Dawley rat. In conclusion, histologic changes of the kidney may be controlled by ANG II regardless of systemic hypertension.

Plasma Atrial Natriuretic Peptide Concentration after Birth in Low Birth Weight Neonates

PURPOSE: Atrial natriuretic peptide(ANP) is a hormone with diuretic and natriuretic properties that is released by the atrial stretch and plays an important role in sodium and volume homeostasis. We studied plasma ANP concentration and the influence of ANP on sodium balance after birth in low birth weight neonates on the basis of 34 wks gestational age when the nephrogenesis was completed. METHODS: Twenty low birth weight neonates without congenital heart disease, respiratory insufficiency, renal disease or sepsis born between June 1997 and December 1997 at Korea University Guro Hospital were enrolled in this study. Blood sampling for ANP was done at 6 hr, 12 hr, 24 hr, 3 days, 4 days and 10 days after birth. FENa was calculated by blood and urine electrolyte and creatinine. We analyzed the correlation of plasma ANP concentration and fractional Na excretion rate(FENa). RESULTS: Plasma ANP concentration of low birth weight neonates less than 34 wks was 63.67+/-12.94pg/ml at 6 hr after birth and peaked at 24 hr(110.67+/-6.34pg/ml). Thereafter, it gradually decreased and reached 42.43+/-21.89pg/ml at 10 days(P<0.05). Plasma ANP concentration of low birth weight neonates more than 34 wks was 25.50+/-8.22pg/ml at 6 hr after birth and peaked at 12hours(152.67+/-39.93pg/ml). Thereafter, it gradually decreased and reached 42.78+/-17.67pg/ml at 10 days(P<0.001). And plasma ANP concentration did not correlate significantly with FENa in low birth weight neonates less than 34 wks(r=0.02, P=0.09), but there was good correlation between plasma ANP and FENa in low birth weight neonates more than 34 wks(r=0.6, P<0.001). CONCLUSION: From the above results, it is concluded that ANP influences renal Na excretion after 34-week gestational age when the development of distal tubule, containing ANP receptors, is rapid and contributes to body fluid and Na homeostasis.

Mumps and Rubella-Specific IgG Levels of Term Pregnant Women and Their Neonates

PURPOSE: This study was performed to evaluate seropositivities in term pregnant women and their neonates, and the transplacental transfer rate of maternal mumps and rubella- specific IgG from term pregnant women to their neonates. METHODS: During Jun. 1, 1994 to Mar. 31. 1995, we collected 44 pairs of sera from pregnant women and their neonates in Anam Hospital of Korea University Medical Center. The serum levels of mumps and rubella-specific IgG was measured using the ELISA method. RESULTS: The seropositivities of Mumps-specific IgG were 84.1% in mothers and 90.9% in neonates. There was significant correlation of mumps-specific IgG levels between maternal sera and neonatal umbilical cord sera (correlation coefficient r=0.856, P<0.001). The mean antibody level of neonates was 1.2 times higher than that of the mothers (P<0.05). The seropositivities of rubella- specific IgG were 38.6% in mothers and 38.6% in neonates. There was significant correlation of rubella-specific IgG levels between maternal sera and neonatal umbilical cord sera (correlation coefficient r=0.8370, P<0.001). There was no significant difference of the mean antibody levels between mothers and neonates. CONCLUSION: The transplacental transport rate and the seropositivities of mumps-specific IgG of mother and neonates were appropriate for expected values, but those of the rubella-specific IgG were lower than expected values. The above results suggest re-evaluating the current vaccination schedules of mumps and rubella in Korea.

A Case of Methylmalonic Acidemia

We experienced a case of vitamin B12 unresponsive methlymalonic acidemia in a 4 day old female, who had poor feeding, dehydration with metabolic acidosis, and hyperammonernia and died at 7 days of age. Diagnosis was made by gas chromatography and mass spectrometry, and this case is probably a methylmalonyl CoA mutase apoenzyme deficiency type.

Tract Infection in Acute Febrile Children

Peripheral neuroepithelioma (PNE) of soft tissue is a malignant neuroectodermal tumor arising from peripheral (nonautonomic) nerve. It may occur in both children and adults, and are highly aggressive neoplasms that rapidly give rise to metastatic disease and death. We exprienced a case of peripheral neuroepithelioma of soft tissue in the upper arm in a 18-year-old female. Cytologic features revealed small round cells with scanty cytoplasm occurring both singly and in clusters. The clusters frequently tended to form Homer-Wright rosettes. The cells had a round to oval nucleus with fine chromatin and in- conspicuous nucleoli in a hemorrhagic background.

Prognostic Value and Histologic Correlation of Sonography in Childhood Nephrotic Syndrome

The uterine cervix is an uncommon site of primary non-Hodgkin's lymphoma (NHL). Although the cytologic findings of NHLs are well known, most cervicovaginal smear of uterine NHLs give lower diagnostic yield than common epithelial malignancy because abnormal cells do not appear in the sample in the absence of surface ulceration. Herein, we describe cytologic findings of a case of uterine cervical NHL which was initially diagnosed by cervicovaginal smear. The tumor cells were relatively uniform, isolated, large-sized with scanty cytoplasm and round or indented nuclei. The nuclei had stippled chromatin and small nucleoli. Histologically and immunohistochemically the tumor was proven to be large cell lymphoma of T-cell lineage.

The Effect of Steroid Therapy on Growth and Bone Density in Children with Nephrotic Syndrome

PURPOSE: Long-term steroid therapy for various glomerular disorders in children has been known to decrease serum Vit D3 level and develop osteomalacia. The aim of this study was to observe the effect of long-term steroid therapy on growth and bone density in children with nephrotic syndrome. METHODS: Bone density of 17 steroid-treated nephrotic syndrome was compared with that of 17 similar aged healthy children by biochemical measurement, bone age and bone mineral density. Serum Vit D3, calcium, phosphorus and alkaline phosphatase were measured and bone mineral content was measured in the lumbar vertebra by dual energy X-ray absorptiometry (HOLOGIC QDR 2000 X-Ray Bone densitometer). RESULTS: There was no significant difference in height ,weight and bone age between the two groups. The mean bone density was significantly lower in children receiving steroid (0.58 +/- 0.04g/cm2) than in the control group (0.65 +/- 0.07g/cm2) (P<0.001). There was no significant correlation between duration of steroid therapy and decrement of bone density. Serum Vit D3 level was significantly lower in the group receiving steroid (16.7 +/- 6.1pg/ml) than in the control group (31.0 +/- 5.8pg/ml) (P<0.001). CONCLUSION: we conclude that alternate-day steroid therapy doesn't affect growth but may lead to decrement of serum Vit D3 level and bone mineral density in children with nephrotic syndrome.

EEG Abnormalities in Henoch-Schonlein Purpura

Schonlein-Henoch purpura is a generalized small vessel vasculitis characterized by nonthrombocytopenic purpura, arthritis, abdominal pain and nephritis. In 1914 Osler described an allergic purpura associated with hemiplegia. After then Lewis et al. reported the cases of Schonlein-Henoch purpura associated with convulsion, coma, confusion, intracranial hemorrhage, and chorea, CNS complication has been reported in 1-8% of children and subsided spontaneously in most cases. Headache is a remarkable sympton and appears nonspecific nature. In 1991 Ostergaard and Storm reported that headache occured during the first week following skin rash and frequently showed abnormal EEG findings. We investigated prospectively the presence of a possible cerebral and renal involvement in the case of Schonlein-Henoch purpura. EEG abnormality demonstrated in 52.6% of all cases, and headache or irritability in 47.4% of all cases. A significant association was found between abnormal EEG finding and presence of headache, but was not found between EEG findings and presence of renal involvement and hypertension. Patients with abnormal EEG had no Past or famity history of febrile convulsion or ididopathic epilepsy.

A Case of Congenital Hypoprothrombinemia

Congenital hypoprothrombinemia is a rare congenital coagulation defect. The clinical signs are manifestation of generalized tendency such as; mucosal bleeding, hypermenorrhea and post tooth extraction hemorrage. It is associated with prolongation of PT and PTT with normal thrombin time and decreased serum prothrombin level. A case with congenital hypoprothrombinemia was experienced by the authors. A 36 days old male baby was admitted with palor skin and vomiting started one day before admission. Right side brain parenchymal hemorrhage and left shift of lateral ventricle were on brain CT scan. Prologation of prothrombin time and partial prothrombin time with decreased serum prothrombin level were resulted. Serum factor I, V, VII, VIII, IX and X were within normal level. We report a case congenital hypoprothrombinemia with a brief review of relaed literatures.

A clinical study on early diagnosis in neonatal sepsis

Neonatal sepsis is a major contributing factor for increased mortality and morbidity in the newbron and its successful outcome depends on early detection and prompt institution of an effective antimic robial therapy. Accurate diagnosis of the neonatal septicemia, however, is quite difficult because its early signs and symptoms are rather subtle. This study was conducted in an attempt to search for useful early markers for the clinical entity A total of 224 newborns, over a 17 month pcriod (1/90 5/91), who were evaluated for probable neonatal sepsis were analysed. The laboratory parameters that showed highest correlation with bacteriologically proves sopsis were as follows: Total WBC counts (0.2), elevated ESR(>15mm/hr), CRP(>6ng/ml). Of the 224 study subjects, 41 had two or more parameters of which 12 subjects had positive blood cultures(positive predictive value:29%), only 4 of the 183 newborns who had less than 2 parameters had positive blood cultures(false negative:2%). It is concluded that the presence of two or more of the above parameters can be used as a strong indicator for neonatal sepsis and its sensitivity is 75% while specificity is 86%.

A case of solid and papilary tumor of pancreas

We report a cases of solid and papillary neoplasm of the pancreas, which is a rare pancreatic tumor. we described clinical characteristics, sonographic, computed tomographic and pathologic finding. The tumors had a smooth, enhanced capsule and variable architecture. The tumor was distributed tail of pancreas without local invasion. the origin of the tumor is probably from a multipotential stem cell of the pancreas. Neoplasm usually behave like a very low grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancrease. This unusual tumor should be considered in the differential diagnosis of a young female with pancreatic mass.