Hematologic Characteristics of Intrauterine Growth Restricted Small for Gestational Age Infants

PURPOSE: Intrauterine growth retardation (IUGR) is the term used to designate a fetus that has not reached its growth potential. However it is difficult to make a distinction between infants who are constitutionally small and growth restricted small. In the present study, we focused on the clinical characteristics and the hematologic value in small for gestational age (SGA) infants and discussed how to distinguish intrauterine growth restricted infants from constitutionally small infants. METHODS: SGA infants that did not have any other risk factors for IUGR in the medical record except maternal hypertension (HTN) and diabetes mellitus (DM) and born at the Seoul St Mary's Hospital and Yeouido St Mary's Hospital from January 2007 to July 2010 were included. The frequency of IUGR is higher in the pregnancy with medical problem, and in preterm infants. Therefore, the data was categorized by maternal disease and gestational age. We assessed the clinical data and the hematologic value. RESULTS: The leukocyte count and the platelet count were lower in the SGA with maternal HTN group and the preterm SGA group. There was no difference in the clinical data and the prognosis resulted from maternal HTN and maternal DM. However, the hematologic difference was not found in the categorization of the preterm SGA group as maternal diasease. CONCLUSION: The results of this study showed that it is possible the low leukocyte count and the low platelet count are the characteristic hematologic features in growth restricted small for gestational age infants.

Risk Factors of Catheter-related Bloodstream Infection Due to Methicillin-resistant Staphylococcus aureus in Very Low Birth Weight Infants

PURPOSE: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased in children and in neonates, and is particularly associated with frequent use of central venous catheter in very low birth weight (VLBW) infants. It is known that the morbidity and mortality of MRSA infection are low in neonates, as compared with adults. The objective of this study was to examine the difference in clinical characteristics between VLBW infants that survived and those that did not, a catheter-related bloodstream infection (CRBSI) of MRSA. METHODS: Thirty-four VLBW infants had laboratory-confirmed bloodstream infection with S. aureus. We examined the incidence, mortality and morbidity of CRBSI, and predictive factors associated with mortality. RESULTS: Twenty-six infants had same pathogen (24 MRSA, 2 Methicillin-sensitive Staphylococcus aureus) in the blood and in the catheter tip. Eight infants (25.8%) died in the CRBSI and they all had MRSA blood infections. Sex ratio, gestational age, duration between blood collection and identification of pathogens, and WBC and platelet count were not significantly different between patients that died from and patients that survived CRBSI of MRSA. C-reactive protein (CRP) was significantly higher in VLBW infants that died. Mean age of onset and hospital day was earlier (9.1+/-6.6 vs. 26.9+/-20.2; P=0.005) and shorter for patients that died (10.1+/-7.0 vs. 73.0+/-32.4; P=0.000). Two survivors had complications of pyogenic arthritis of the lower extremities and soft tissue infection, respectively. CONCLUSION: Mortality of CRBSI was likely to be high in VLBW infants and might be anticipated by CRP and early onset of disease.

Diagnostic Yield of Pediatric Colonoscopies Based on Presenting Symptoms in a Secondary Hospital / 대한소아소화기영양학회지

PURPOSE: We performed this study retrospectively to review the diagnostic yield of colonoscopies in children and adolescents with various gastrointestinal symptoms and to investigate the relationship between presenting symptoms and the colonoscopic findings in a secondary hospital. METHODS: We reviewed the medical records of patients under the age of 19-years who underwent ileocolonoscopy between January 2001 and December 2010. The total number of patients (n=238) were divided into three age groups and six symptom groups. We analyzed clinical characteristics and the colonoscopic findings, and compared the colonoscopic yield between each groups. RESULTS: The median age of the patients was 16.1 (3.1~18.9) years. The most common presenting symptoms were lower gastrointestinal (GI) bleeding (48.1%) in the or =16 years group (n=126). Positive colonoscopic findings were found in 21.4% of the bowel habit change group (n=28), 51.9% of the low GI bleeding group (n=54), 37.7% of the chronic diarrhea group (n=69), and 94.4% of the group with suspected inflammatory bowel disease (IBD) (n=18), 38.9% of the chronic abdominal pain group (n=54) and 13.3% of the anemia group (n=15). The diagnostic yield of the total examination was 42.0%. The suspected IBD group had a higher yield than the presenting symptom groups (p<0.001). CONCLUSION: Colonoscopy is a safe and useful investigation in children and adolescents with suspected colonic disease. The diagnostic yield of colonoscopy is higher in patients presenting with suspected IBD. Pediatricians practicing in primary or secondary care settings should recommend colonoscopy for patients with suspected IBD.

Comparison of TIMI Myocardial Perfusion Grade with Coronary Flow Reserve for Prediction of Recovery of LV Function and LV Remodeling in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The TIMI myocardial perfusion (TMP) grade is known as one of the methods to assess the viability of the myocardium in ischemic heart disease. This study was designed to assess the value of TMP grade itself and to evaluate the correlation with coronary flow reserve (CFR) in the prediction of left ventricular remodeling and functional change after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). SUBJECTS AND METHODS: We measured CFR and TMP grade after successful elective PCI (diameter stenosis <0%, and TIMI flow 3) in 83 patients (mean age 55+/-1 years, 18 females) with AMI within 7 days of symptom onset. Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), ejection fraction (LVEF), and left ventricular regional wall motion score index (LVRWMSI) were assessed by echocardiography just before and at 9 months after angioplasty (mean 9+/-5 months). RESULTS: Although they had achieved (TIMI 0.021) TIMI 3 flow after successful intervention, 27 of 83 patients (32.5%) had impaired myocardial perfusion. After PCI, angiographic TMP grade was well correlated with CFR measured using Doppler wire (TMP 0/1;1.4+/-0.3, TMP 2;1.9+/-0.6, TMP 3;2.2+/-0.4, rs=0.618, p=0.000). Post-PCI TMP grade was significantly related to the change of LVEDVI (r=0.452, p=0.000), LVESVI (r=0.435, p=0.000), LVEF (r=0.281, p=0.010) and LVRWMSI (r=0.328, p=0.036). CONCLUSION: The TMP grade, a simple angiographic method, might be useful as a predictor of LV volume and functional change in AMI. In the cardiac catheterization laboratory, it could simply replace CFR for the assessment of myocardial viability in patients who receive an elective PCI within 7 days of AMI onset.

Factors associated with clinical severity determined by requirement for systemic corticosteroid therapy in adult asthmatic patients / 천식및알레르기

BACKGROUND: Most studies involving factor analysis on clinical severity of bronchial asthma are short-term and cross-sectional. OBJECTIVES: We evaluated the clinical severity of bronchial asthma according to requirement of systemic corticosteroid therapy, and analyzed the factors associated with long-term systemic corticosteroid therapy. METHODS: The records of 158 asthmatic patients (including 76 patients followed for one year) visiting the clinic of Allergy-Immunology of Ajou University Hospital between June, 1997 and May, 1999 were reviewed retrospectively. RESULTS: Among the 76 asthmatic patients who had been followed-up for one year, asthmatic patients (n=28) treated with systemic corticosteroid for more than 60 days had lower initial FEV1(% predicted) values (p=0.001), lower prevalence of concomitant allergic diseases (p= 0.04), and lower frequency of allergen-specific immunotherapy (p=0.006) than asthmatic patients treated with systemic corticosteroid for less than 60 days (n=48). Among the 158 asthmatic patients, 87 patients (55%) were atopic asthmatics and 71 patients (45%) were nonatopic asthmatics. Nonatopic asthmatics showed older age at initial visit (p<0.001), lower serum total IgE levels (p=0.02), lower prevalence of concomitant allergic diseases (p=0.004), and higher prevalence of aspirin-sensitivity (p<0.001) than atopic asthmatic patients. Among the 76 patients followed for one year, nonatopic asthmatic patients were treated with significantly higher cumulative-doses of systemic steroid than atopic asthmatic patients (p=0.04). CONCLUSION: Initial pulmonary function and nonatopy are significantly associated with clinical severity determined by requirement of systemic corticosteroid therapy in adult asthmatic patients.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia in a Patient with Dextrocardia Associated with Atrial Septal Defect

It is known that tachyarrhythmias in patients with congenital heart defects have a potentially high impact on quality of life, morbidity and mortality. Conventional treatment with antiarrhythmic drugs may have untoward results including recurrence of tachyarrhythmia and its adverse effects. Therefore, radiofrequency catheter ablation is increasingly used for the treatment of supraventricular tachycardias in patients with congenital heart diseases, although abnormal anatomy and atypical conduction systems have the potential to complicate catheter ablation procedures. This report describes our experience with the successful radiofrequency catheter ablation of atrio-ventricular nodal reentrant tachycardia (AVNRT) in a patient with dextrocardia with situs solitus (isolated dextrocardia).

A Case of a Retained Surgical Sponge Diagnosed by Colonoscopy / 대한소화기내시경학회지

Gossypibomas, retained surgical sponges are prone to creat adhesions and to encapsulate, or to provoke an exudative response, with or without accompanying bacterial infection. Often a process of transmural migration can occur and we experienced a case which was diagnosed by colonoscopy. A 24 year-old female patient who had a history of Cesarean section 4 months ago came to the hospital with a complaint of intermittent right lower quadrant pain. A thread of surgical sponge was found by colonoscopy from ascending colon to cecum. At laparotomy, a transmurally migrating surgical sponge through the colonic fistula at the cecal base with surrounding abscess cavity was found. Adding a case report, the fate of intraperitoneal forgotten surgical sponges is reviewed.

Predictors of Arrhythmic Events in Idiopathic Dilated Cardiomyopathy

BACKGROUND AND OBJECTIVES: Previous studies have indicated that idiopathic dilated cardiomyopathy (IDCM) is associated with a high incidence of lethal ventricular arrhythmia and sudden cardiac death (due to arrhythmic events). The objective of this study was to evaluate predictive factors of arrhythmic events in IDCM. SUBJECTS AND METHODS: A total of 174 patients with IDCM were evaluated for the measurement of multiple parameters such as PR interval, QRS duration, rate corrected QT dispersion, bundle branch block, atrial fibrillation, left ventricular end diastolic dimension, ejection fraction, left atrial size, and left ventricular hypertrophy. The patients were divided into 2 groups:group A with and group B without arrhythmic events. RESULTS: Over an observation period of 38+/-19 months, arrhythmic events developed in 39 of the 174 patients (4 VT, 1 VF and 34 sudden cardiac death, 22.4%). In multivariate analysis, only QTDc was found to be an independent predictor of arrhythmic events (RR:1.03, 95% CI:1.01 - 1.04, p108 ms were 43.8% (7/16) and 85.6% (83/97) respectively. The positive predictive value of arrhythmic events in patients with QTDc>108 ms and EF<28% was 66.6% (8/12). CONCLUSION: The extent of repolarization dispersion and LV systolic function was determined to have value as a useful screening test for the prediction of arrhythmic events in IDCM.

Prevalence of HBV Genotypes in Korean Patients with Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: Hepatitis B virus (HBV) genotypes have distinct geographic distributions. The possibility of pathogenic differences among HBV genotypes has been suggested. We investigated the prevalence of HBV genotypes in Korea and the association between distinct genotypes and clinical outcomes. METHODS: Using a PCR-RFLP and sequencing, HBV genotypes were determined in 136 patients with chronic type B hepatitis. RESULTS: The genotype C was detected in 131 patients (96.3%), and other 5 patients (3.7%) had genotype B. There were no significant differences in sex, age, disease duration, ALT level, HBeAg/anti-HBe status, or HBeAg loss between genotype B and C patients. CONCLUSIONS: These results suggest that almost all patients with chronic hepatitis B are infected with genotype C. Genotypes do not influence the outcome of chronic hepatitis B patients in Korea.