Significance of Postoperative Peritoneal Drainage and Peritoneal Dialys is in Infants with congenital Heart Disease Who Underwent Open Heart Srugery

PURPOSE: We reviewed 5 years worth of experience with peritoneal drainage and dialysis in infants who underwent open heart surgery. The aim of this study was to investigate the effect of peritoneal drainage and peritoneal dialysis on fluid balance and several parameters of intensive care. METHODS: Six(10%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis during peritoneal drainage. Simple peritoneal drainage was performed in the remaining 54 infants. The silicone rubber peritoneal dialysis catheter was inserted into the center of abdominal cavity just after operation, and subsequent peritoneal drainage was maintained during intensive care. RESULTS: Mean age of the study group was 0.48+/-0.21 years(M: F=32: 28). Early postoperative mortality amang the infants with congenital heart disease was 1.6%. Total amount of output was 7.0+/-2.28mL/kg/hr, urine output 5.14+/-2.9lmL/kg/hr, pleural fluid 0.80+/-0.5lmL/kg/hr, and peritoneal fluid 1.20+/-0.90mL/kg/hr. The ratio of output to intake(O/I) was 1.06. None of the complications required early termination of peritoneal drainage or peritoneal dialysis. Hemodynamics and pulmonary function were maintained steadily during postoperative intensive care. CONCLUSION: The early institution of peritoneal drainage and peritoneal dialysis in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.

The Effects of Zinc Ion on the Adriamycin-Induced Apoptosis of HL-60 Cells / 대한소아혈액종양학회지

PURPOSE: The widely used chemotherapeutic agents exert their anti-cancer effects by the inducing of apoptosis in sensitive tumor cells. Recently, the protective effect of zinc ion on apoptosis has been reproted. However, it is not well understood about the effects of zinc ion on the anticancer drug-induced apoptosis. In general, zinc inhibits a nuclear endonuclease, thereby causing inhibition of apoptosis. In addition, there is other possibility that zinc can prevent apoptosis at earlier stage such as the activation of caspase-3 than that of the activation of endonuclease. Therefore, we investigated the effects of zinc ion on the apoptosis of HL-60 cells caused by adriamycin (ADR). METHODS: HL-60 cells were cultured in RPMI 1640 and treated with various concentrations and time periods of ADR with or without pretreatment of zinc ion. Cellular DNA was extracted and analyzed by electrophoresis on a 1.5% agarose gel to detect DNA fragmentation. The activity of caspase-3 was measured by the proteolytic cleavage of the fluorogenic substrate DEVD-AMC. Poly-ADP-ribose polymerase (PARP) cleavage was analyzed by western blotting using anti-PARP antibody. RESULTS: ADR induced the apoptotic death of HL-60 cells in a dose and time dependent manner, which was characterized by increasing ladder-pattern DNA fragmentation. Pretreatment of HL-60 cells with zinc ion caused potent inhibition of ADR-induced apoptosis. Consistent with apoptotic death of HL-60 cells, ADR induced the catalytic activation of caspase-3. After pretreatment of zinc ion, the activation of caspase-3 and the proteolysis of PARP induced by ADR were markedly inhibited. CONCLUSION: These results indicate that zinc ion prevents the ADR-induced apoptosis of HL-60 cells through an inhibition of caspase-3 activity, which occurs upstream from the activation of endonuclease.

Growth Hormone and Cortisol Responses to Insulin Stimuli in Children with Short Stature / 대한소아내분비학회지

PURPOSE: For evaluation of the growth hormone and cortisol responses to insulin stimuli in children with short stature, the human growth hormone secretion and cortisol level was monitored 30 and 60 minutes after insulin infusion by intravenousely. METHODS: The inclusion criteria of children for this study were that the height was below 3 percentile compare with the same sex and age children, bone age was younger more than one year of chronologic age, and insulin and L-dopa induced growth hormone secretion was below 10ng/mL. There were 10 children compatible with this criteria(group A) and 11 children was selected for control group(group B). Serum concentration of growth hormone was determined just before intravenous infusion of 0.1U/kg insulin and then 30 and 60 minutes after insulin infusion. Serum level of cortisol was determined simultaneously with the growth hormone but skip the level of the 30 minutes after insulin infusion. Serum glucose level was monitored on every time sampling the blood for determined growth hormone and cortisol level. Serum level of growth hormone and cortisol were determined by radioimmunoassay. RESULTS :The serum glucose concentration were decrease to under 50% of baseline level on 30 minutes after insulin infusion in A and B group. The serum growth hormone level before insulin infusion was 2.5+/-1.78ng/mL and changed to 2.2+/-1.69 ng/mL on 60 minutes after insulin infusion in group A. In group B, the serum growth hormone level alteration before and on 60 minutes after insulin infusion was from 5.5+/-6.67ng/mL to 12.6+/-7.91ng/mL. The serum concentration of cortisol was changed from baseline level 10.7+/-7.10, 7.9+/-3.98microg/dL to 16.7+/-11.47, 26.1+/-3.59microg/ dL on 60 minutes after insulin infusion in group A and B respectively, but some cases in group A show a little increase in cortisol level. CONCLUSION: On the basis of this study, it is suggested that the deficiency of growth hormone secretion is related to cortisol concentration in peripheral blood. But for more detailed assessment of this association, follow up studies will be needed in more cases.

A Case of Matemal Hemorrhage

Fetomaternal hemorrhage is very common and the commonest cause of anernia in the newborn. But, few blood cells enter the maternal circulation in most pregnancies. Occasionally large intrauterine bleeding results in severe fetal and neonatal anemia, shock, and rarely death. To identify the fetal blood in the maternal circu1ation, acid elution technique of Kleihauer-Betke test is usually used. And imrnedate neonatal blood transfusion should be done for good prognosis. We report a case of massive feto-maternal hemorrhage (>100 ml) in a preterm neonate with severe anemia at birth, which was diagnosed by Kleihauer-Betke test and was treated with blood transfusion.

Comparison of Various Doppler Echocardiographic Methods for Estimation of Pulmonary Artery Pressure

BACKGROUND: Noninvasive estimation of pulmonary artery pressure is an important component of echocardiographic studies. A number of methods are available for estimation of pulmenary pressure, each with varying degrees of reported accuracy. To assess accuracy and difficulties, noninvasive pulmonary artery pressure estimates were performed in infants and children with congenital heart diseases. METHODS: Noninvasive estimates from 8 methods were compared with catheterization measurements. Systolic pressure was estimated by the Burstin method and from perak tricuspid regurgitation velocity, and also from systolic pressure gradients through the VSD(ventricular septal defect) and PDA(patent ductus arteriosus). Mean pressure was estimated by acceleration time divided by ejection time measured from Koppler spectrum obtained at the right ventricular out flow tract. Diastolic pressure was estimated from pulmonary regurgitation velocity spentrum at end-diastolic, and also from diastolic pressure gradient through the patent ductus arteriosus. RESULTS: IN systolic pressure, Burstin and tricuspid regurgitation velocities estimates correlated significantly(r=0.92, 0.90 respectively), whereas VSD and PDA estimates correlated less well with catheterization estimates(r=0.83, 0.65 respectively). The mean pressure, measured from RVOT(right ventricular outflow tract) Doppler spectrum corresponded well with catheterization pressure(r=0.89), whereas those obtained from the main pulmonary artery correlated less well(r=0.74). The diastolic pressure estimates from pulmonary regurgitation velocity spectrum, revealed good correlation(r=0.79), but those from diastolic Doppler spectrum at PDA correlated less well with catheterization estimates(r=0.63). CONCLUSION: All of eight Doppler echocardiographic methods seemed to be easily performable for estimation of pulmonary artery pressure. But, the degree of accuracy was variable. Because a pressure estimante from only a single method may be in error, care should be taken in combining use of other(one or two) methods.