Early stress hyperglycemia as independent predictor of increased mortality in preterm infants / 소아과

Purpose: Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods: In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results: There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion: Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.

Echocardiographic Assessment of Left Ventricular Diastolic Function in Transitional Circulation Period

BACKGROUND AND OBJECTIVES: During the transitional period from fetal to neonatal life, there are dramatic changes in the newborn circulation. Among these changes, the left ventricular diastolic function can be easily assessed by Doppler measurement of the mitral inflow. However, there are many physiologic and hemodynamic factors responsible for the mitral inflow. This study was designed to evaluate several parameters that represent the left ventricular function during the transitional circulation period. SUBJECTS AND METHODS: Eighteen normal full-term infants were studied by serial two-dimensional, Doppler and color flow echocardiography within 24 hours before and after birth, between 2 days and 6 days after birth and between 7 days and 30 days after birth). RESULTS: One day after birth, the mitral valve (MV) E velocity and E/A increased (37.9+/-7.5 vs. 60.3+/-9.0 and 0.8+/-0.1 vs. 1.1+/-0.1, p<0.01, respectively), but the MV A velocity, the velocity of propagation (Vp), the LV isovolumic relaxation time (IVRT), the corrected IVRT and the tissue Doppler ventricular septum e' and s' did not change. Although Vp/E and a' decreased (1.2+/-0.3 vs. 0.7+/-0.2 and 8.2+/-1.8 vs. 6.5+/-1.7, p<0.05, respectively), the E/e' and the systolic and diastolic pulmonary venous flow velocities increased after birth (6.3+/-1.9 vs. 11.6+/-2.9, and 26.1+/-6.7 vs. 64.5+/-9.6, and 20.9+/-4.1 vs. 63.5+/-17.2, p<0.05, respectively). CONCLUSION: Increased preload plays a key role for the increased MV E/A ratio after birth. Other unknown factors (and possibly including pericardial restriction) may be also responsible for left ventricular diastolic function.

Adenocarcinoma Arising in Adenomyosis

Adenocarcinoma in adenomyosis is unusual and it is mostly associated with adenocarcinoma in the endometrial mucosa. In contrast, adenocarcinoma arising in adenomyosis without endometrial adenocarcinoma is extremely rare and it suggests that it arises de novo from adenomyosis. We report a case of adenocarcinoma arising in adenomyosis in 44-year-old woman. The endometrial cavity contained a polypoid lesion with atypical hyperplasia, but no evidence of adenocarcinoma in the endometrial mucosa. Simple, complex and atypical hyperplasia associated with well differentiated adenocarcinoma was also noted in the areas of adenomyosis.

Sirenomelia: An autopsy case report

Sirenomelia is a severe form of caudal regression syndrome that results in a fusion of the lower extremities, which is not compatible with life. A various spectrum of anomalies affecting primarily the musculoskeletal, genitourinary and gastrointestinal systems also can occur. This rare malformation has a reported incidence rate of approximately 1 in 60,000 births, with a range of 1 to 1 percent of all malformed infants. We experienced a sirenomelic case with combined anomalies of genitourinary, cardiovascular and gastrointestinal systems. Maternal obstetric history revealed oligohydramnios and intrauterine fetal growth retardation, and the baby was spontaneously delivered at 37 weeks of gestational age, but died I hour after birth.

Immunologic and morphologic study of experimental IgA nephropathy in ddY mice after administration of cyclosporin A(CsA) / 대한신장학회잡지

No abstract available.

Congenital Hepatic Fibrosis: A case report

Congenital hepatic fibrosis is an uncommon disease of children and young adults with two major risks: gastrointestinal hemorrhage caused by portal hypertension, and cholangitis related to bacterial infection of dilated intrahepatic bile ducts. It is characterizeed by stony hard hepatomegaly and portal hypertension with rather well preserved hepatic function and architecture, and frequent association of the renal lesions. We have recently experienced a case of congenital hepatic fibrosis in a 24 year-old Korean male. The chief complaint was hematemesis from esophageal varices. There were marked hepatosplenomegaly, mild pancytopenia and the liver function test was within normal engorgement and dilatation of portal and splenic veins and multiple cysts of both kidneys.

Hemangiopercytoma of the Meninges: The immunohistochemical study for the relationship between hemangiopericytic meningioma and peripheral hemangiopericytoma

Hemangiopericycic maningioma is clinically and pathologically similar to peripheral Hemangiopericytoma and now tends to be terned as hemangiopericytoma of central nervous system. The authors studied 3 cases of hemangiopericytic meningioma obtained from 3 patients, 1 case of meningotheliomatous meningioma, angioblastic meningioma and transitional meningioma, and 2 cases of peripheral hemangiopericytoma, which had operated from November 1988 to May 1989 at the department of neurosurgery, Pusan Inje University Hospital. The authors analysed and compared the immunohistochemical finding and light microscopic apearance. The results obtained were summarized as follows; 1) Classic maningioma (meningotheliomatous meningioma, transitional meningioma and angioblastic meningioma) shows reactivity to both EMA and vimentin. 2) Hemangiopercicytic meningioma and peripheral hemangiopericytoma are reactive only to vimentin, so the two tumors are suggested as same type of tumor. 3) One of 3 cases of hemangiopericytic meningioma shows whorling and interlacing bundles of spindle cells, the peculiar light microscopic features of transitional meningioma, suggesting transitional or mixed form of hemangiopericytic meningioma and transitional meningioma.

Hemangiopercytoma of the Meninges: The immunohistochemical study for the relationship between hemangiopericytic meningioma and peripheral hemangiopericytoma

Hemangiopericycic maningioma is clinically and pathologically similar to peripheral Hemangiopericytoma and now tends to be terned as hemangiopericytoma of central nervous system. The authors studied 3 cases of hemangiopericytic meningioma obtained from 3 patients, 1 case of meningotheliomatous meningioma, angioblastic meningioma and transitional meningioma, and 2 cases of peripheral hemangiopericytoma, which had operated from November 1988 to May 1989 at the department of neurosurgery, Pusan Inje University Hospital. The authors analysed and compared the immunohistochemical finding and light microscopic apearance. The results obtained were summarized as follows; 1) Classic maningioma (meningotheliomatous meningioma, transitional meningioma and angioblastic meningioma) shows reactivity to both EMA and vimentin. 2) Hemangiopercicytic meningioma and peripheral hemangiopericytoma are reactive only to vimentin, so the two tumors are suggested as same type of tumor. 3) One of 3 cases of hemangiopericytic meningioma shows whorling and interlacing bundles of spindle cells, the peculiar light microscopic features of transitional meningioma, suggesting transitional or mixed form of hemangiopericytic meningioma and transitional meningioma.

Effect of Fibrin Glue(Tissel(R))in Experimental Corneal Perforation

Fibrinogen is converted into fibrin by the action of thrombin under presence of calcium. In addition to its hemostatic effect, fibrin coagulum has tissue adhesive effect and fibroblast stimulating effect in the healing process. Perforating wounds about 1mm X 3mm in size were made in the center of rabbit corneas, and then were treated with fibrin glue. Simple full-thickness lacerations were also made in the central cornea of the other eye without any treatment as a control group. These eyes were enucleated after various periods of interval and the wound sites were studied with light and electron microscope. Tissue defect of perforated cornea was closed well by fibrin glue and active proliferation of the fibroblasts was seen near the glue. From these results, fibrin glue may be useful in the treatment of human corneal perforation and it will be used for the other ocular surgery.

Effect of Fibrin Glue(Tissel(R))in Experimental Corneal Perforation

Fibrinogen is converted into fibrin by the action of thrombin under presence of calcium. In addition to its hemostatic effect, fibrin coagulum has tissue adhesive effect and fibroblast stimulating effect in the healing process. Perforating wounds about 1mm X 3mm in size were made in the center of rabbit corneas, and then were treated with fibrin glue. Simple full-thickness lacerations were also made in the central cornea of the other eye without any treatment as a control group. These eyes were enucleated after various periods of interval and the wound sites were studied with light and electron microscope. Tissue defect of perforated cornea was closed well by fibrin glue and active proliferation of the fibroblasts was seen near the glue. From these results, fibrin glue may be useful in the treatment of human corneal perforation and it will be used for the other ocular surgery.

A Case of Renal Oncocytoma / 대한비뇨기과학회지

The renal oncocytoma is a rare benign tumor arising from the proximal tubular cells and has recently become a recognized clinical and pathologic entity. The feature of this tumor includes the tendency to (1) be incidental finding, (2) be large in size, (3) have well defined borders, (4) exhibit benign clinical behaviors. Here, we report a case of renal oncocytoma which was found incidentally due to pelvic inflammatory disease of a 37-years-old woman, who was treated with the radical nephrectomy.

Leiomyosarcoma of the Breast

Leiomyosarcoma of the breast is extremely rare. The natural history of leiomyosarcoma of the breast remains largely unknown because of the low incidence and lack of long-term follow up. But leiomyosarcoma of the breast appears to be less aggressive biologically than other sarcomas of the breast such as rhabdomyosarcoma. In an attempt to define diagnostic criteria of smooth muscle tumors of the breast, the reported cases of leiomyoma of the breast and nipple were also reviewed and compared with leiomyosarcomas by Chen et al(1981). Based on the result of this review, tumors with three or more mitoses per 10 HPF are leiomyosarcoma and those with no mitosis, necrosis, and significant atypia are leiomyomas. We have experienced a case of leiomyosarcoma of the breast. The patient was a 39 year-old female and was admitted due to a rapid growing right breast mass. The breast mass was noted 4 years ago and then this year the mass growed rapidly. Simple mastectomy was performed. Grossly the mass measured 11.0x8.0x8.0 cm in dimensions and was well circumscribed, pinkish, multinodular, and it was protruded from the cut surface. Microscopically the mass is composed of interlacing bundles of spindle shaped cells and multifocal large areas of hyalinized collagenous tissue. The individual spindle cells are slightly pleomorphic and occasionally show mitotic figures, 6~7 per 10 HPF in the most cellular area.