Fetal Intra-abdominal Umbilical Vein Varix Complicated with Patent Ductus Venosus and Atrial Septal Defect / 대한주산의학회잡지

Umbilical vein varix has diverse clinical features and an unpredictable course during the pregnancy and/or perinatal period. We report a rare case of isolated fetal varix of the intra-abdominal umbilical vein, which was associated with fetal cardiomegaly. After birth, the umbilical vein varix remained with continuous blood flow through the patent ductus venosus. In addition, persistent cardiomegaly was complicated with an atrial septal defect.

Fetal Echocardiographic Measurements of Aortic Arch between 20 and 38 Gestational Weeks: Normative Data for Various Fetal Growth Parameters / 대한주산의학회잡지

PURPOSE: Assessment of the diameters of the aortic arches in the human fetus may be helpful in the prenatal diagnosis of aortic arch anomalies. The purpose of this study is to construct valuable reference ranges of fetal aortic arch for various fetal growth parameters in an unselected Korean population. METHODS: A prospective, cross-sectional study was performed in 98 normal singleton fetuses between 20 and 38 weeks of gestation. The transverse aortic arch diameter (TAD) and distal aorta isthmus diameter (AID) were measured in the longitudinal view during systole. The bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were obtained at the same time. Ultrasound examinations were performed with a 2.0-6.0 MHz convex probe by abdominal ultrasound. RESULTS: TAD and AID as a function of gestational age (GA) was expressed by the regression equation TAD= -1.246+0.168 X GA, and AID = -1.341+0.180 X GA; TAD and AID are expressed in millimeters and GA in weeks. TAD and AID as a function of BPD was expressed by the regression equation TAD= -1.147+0.664 X BPD, and AID = -1.152+0.696 X BPD. TAD and AID as a function of HC was expressed by the regression equation TAD = -1.187+0.182 X HC, and AID = -1.350+0.198 X HC. TAD and AID as a function of AC was expressed by the regression equation TAD = -0.528+0.173 X AC, and AID = -0.533+0.183 X AC. TAD and AID as a function of FL was expressed by the regression equation TAD = -0.519+0.799 X FL, and AID = -0.601+0.860 X FL; BPD, HC, AC and FL are expressed in centimeters. Correlations were found to be highly statistically significant in relation to GA, BPD, HC, AC, and FL respectively (P<0.0001 in all). Normal mean of TAD and AID per GA, BPD, HC, AC and FL and 95% prediction limits were also defined, respectively. CONCLUSION: New reference ranges of fetal aortic arch related to other fetal bio-parameters representing fetal growth were obtained successfully. The normative date will be helpful in the prenatal accurate diagnosis of aortic anomalies and abnormal growth of fetal aortic arches in Korea.

Gene Expression of Endothelin-1 and Endothelin Receptor A on Monocrotaline-Induced Pulmonary Hypertension in Rats After Bosentan Treatment

BACKGROUND AND OBJECTIVES: Endothelin (ET)-1, a potent endothelium-derived vasoconstrictor peptide, has a potential pathophysiologic role in pulmonary hypertension. Bosentan, a dual ET receptor (ET(A)/ET(B)) antagonist, is efficacious in treatment of pulmonary hypertension. The objectives of this study were to investigate the expression of ET-1 and ET receptor A (ERA) genes and to evaluate the effect of bosentan in monocrotaline (MCT)-induced pulmonary hypertension. MATERIALS AND METHODS: Four-week-old male Sprague-Dawley rats were treated as follows: control (n=36), subcutaneous (sc) injection of saline; MCT (n=36), sc injection of MCT (60 mg/kg); and bosentan (n=36), sc injection of MCT (60 mg/kg) plus 25 mg/kg/day bosentan orally. RESULTS: Serum ET-1 concentrations in the MCT group were higher than the control group on day 28 and 42. Quantitative analysis of peripheral pulmonary arteries revealed that the increase in medial wall thickness after MCT injection was significantly attenuated in the bosentan group on day 28 and 42. In addition, the increase in the number of intra-acinar muscular arteries after MCT injection was reduced by bosentan on day 14, 28 and 42. The levels of ET-1 and ERA gene expression were significantly increased in the MCT group compared with control group on day 5, and bosentan decreased the expression of ET-1 on day 5. CONCLUSION: ET-1 contributes to the progression of cardiopulmonary pathology in rats with MCT-induced pulmonary hypertension. Administration of bosentan reduced ET-1 gene expression in MCT-induced pulmonary hypertension in rats.

Effect of endothelin receptor blockade on monocrotaline-induced pulmonary hypertension in rats / 소아과

PURPOSE: To examine the effect of bosentan, a dual endothelin receptor (ER) antagonist, on the development of monocrotaline (MCT)-induced pulmonary hypertension in rats by especially focusing on the pulmonary vascular morphology changes. METHODS: Sprague-Dawley rats were treated as follows: controls received a subcutaneous saline injection, MCT-treated rats received a subcutaneous MCT injection, and bosentan-treated rats received a MCT injection followed by treatment with bosentan (20 mg/kg/day). To assess the effects of ER blockade on the time course, the animals were exsanguinated, and their hearts and lungs were dissected after 7, 14, or 28 days. RESULTS: The mean body weights of the MCT- and bosentan-treated rats were significantly lower than that of the control rats on days 7, 14, and 28. Bosentan administration significantly inhibited the progression of right ventricular hypertrophy on day 28 (right ventricle/[left ventricle+septum]: 0.71+/-0.10 in MCT-treated rats vs. 0.49+/-0.09 in bosentan-treated rats; P<0.05). Quantitative analysis of peripheral pulmonary arteries revealed that the increase in medial wall thickness after MCT injection was significantly attenuated in the bosentan-treated rats on day 28 (49.96+/-10.06% in MCT-treated rats vs. 47.09+/-10.48% in bosentan-treated rats; P<0.05). In addition, the increase in the number of intra-acinar muscular arteries after MCT injection was reduced by bosentan on days 14 and 28. CONCLUSION: Bosentan administration in intermediate doses exerts inhibitory effects on lung vascular hypertrophy and right ventricular hypertrophy during the development of MCT-induced pulmonary hypertension in rats.

Somatostatin for Postoperative Chylothorax after Surgery for Children with Congenital Heart Disease

Chylothorax is a rare but serious postoperative condition with a high rate of morbidity that may lead to death of children with congenital heart disease. Here we reviewed nine consecutive cases with chylothorax in infants and children following cardiac surgery from March 2002 to February 2003. Somatostatin was added to conservative treatment proctocol to increase effectiveness of therapy in all cases. The duration of somatostatin therapy varied from 7 to 32 days. All cases of chylothorax were successfully treated with intravenous infusion of somatostatin as an adjunctive treatment. Even though two cases showed rebound phenomena, we avoided any surgical procedure in the nine patients who treated with conservative management combined with somatostatin. No significant side effects of somatostatin were observed. It seems that somatostatin is effective, noninvasive and safe therapeutic modality. It can be used as an adjunctive treatment to conservative management to control postoperative chylothorax in children with congenital heart disease.

Carriage and Antimicrobial Susceptibility of Haemophilus influenzae Isolated from Oropharynges of Children

PURPOSE: Haemophilus influenzae, one of the normal flora of the upper respiratory tract, can cause such infections as otitis, sinusitis, pneumonia, and meningitis in children. The oropharyngeal flora has therefore mainly been analyzed as a reservoir for pathogens. This study was performed to reveal the colonization rate of H. influenzae in the upper respiratory tract, their biotypes, their antimicrobial resistance and production of beta-lactamase in healthy children. METHODS: The specimens for H. influenzae were obtained through oropharyngeal swab from 209 healthy children, younger than 5 years of age in 4 day care centers from March 1998 to June 1998. These isolates of H. influenzae were tested for their biotypes, in vitro susceptibility to seven antimicrobial agents(ampicillin, ampicillin/sulbactam, aztreonam, chloramphenicol, cefotaxime, tetracycline and trimethoprim-sulfamedoxazole) by disc diffusion method and production of beta- lactamase. RESULTS: The carriage rate of H. influenzae in the day care center children was 13.4%(28/209). Of 24 isolates, 8 isolates(33%) were biotype II and 6 isolates(25%) were biotype I. The overall rates of resistance of 15 isolates are as follows; ampicillin 46.7%, tetracycline 28.6%, trimethop rim-sulfamedoxazole 14.3%, ampicillin/sulbactam 6.7%. The prevalence of beta-lactamase producing isolates was 65.2%. All beta-lactamase producing isolates were resistant to ampicillin. The resis tance rates of beta-lactamase producing isolates to tetracycline, trimethoprim-sulfamedoxazole, and ampicillin/sulbactam were 44.4%, 25.0%, and 11.1%, respectively. CONCLUSION: Children in day care centers in Seoul have high rates of H. influenzae carriage. The antimicrobial resistance of H. influenzae from the oropharyngeal specimens of healthy children was higher than expected.

The Utility of Serum Prealbumin Concentrations for Short-term Nutritional Assessment in Patients with Acute Diarrhea

PURPOSE: To evaluate the usefulness of serum prealbumin concentration for the nutritional assessment of acute diarrhea. METHODS: From February 1997 to August 1997, ninety patients with acute diarrhea(age, 4-24 months) were randomly assigned into two groups on the basis of their intakes for 2 days prior to admission : liquid diet group(N=56, clear liquid and/or oral electrolyte solutions), and formula and soft diet group(N=34). Serum prealbumin concentrations were measured by rate nephelometric microassay. RESULTS: Serum prealbumin concentration in the liquid diet group with acute diarrhea was 13.1+/-4.5mg/dL which was significantly lower than 15.5+/-5.0mg/dL of the formula and soft diet group (P<0.05) and 17.0+/-4.0mg/dL of the control group(P<0.05). Serum prealbumin concentration was less influenced by dehydration than serum albumin concentration. The duration of diarrhea and admission were not significantly shorter in the liquid diet group than in the formula and soft diet group. CONCLUSION: Serum prealbumin concentrations in patients with acute diarrhea reflected their current nutritional status and was less influenced by dehydration than serum albumin concentrations. Serum prealbumin concentration might be used to monitor short-term nutritional deprivation and the adequacy of dietary supply.

The Utility of Serum Prealbumin Concentrations for Short-term Nutritional Assessment in Patients with Acute Diarrhea

PURPOSE: To evaluate the usefulness of serum prealbumin concentration for the nutritional assessment of acute diarrhea. METHODS: From February 1997 to August 1997, ninety patients with acute diarrhea(age, 4-24 months) were randomly assigned into two groups on the basis of their intakes for 2 days prior to admission : liquid diet group(N=56, clear liquid and/or oral electrolyte solutions), and formula and soft diet group(N=34). Serum prealbumin concentrations were measured by rate nephelometric microassay. RESULTS: Serum prealbumin concentration in the liquid diet group with acute diarrhea was 13.1+/-4.5mg/dL which was significantly lower than 15.5+/-5.0mg/dL of the formula and soft diet group (P<0.05) and 17.0+/-4.0mg/dL of the control group(P<0.05). Serum prealbumin concentration was less influenced by dehydration than serum albumin concentration. The duration of diarrhea and admission were not significantly shorter in the liquid diet group than in the formula and soft diet group. CONCLUSION: Serum prealbumin concentrations in patients with acute diarrhea reflected their current nutritional status and was less influenced by dehydration than serum albumin concentrations. Serum prealbumin concentration might be used to monitor short-term nutritional deprivation and the adequacy of dietary supply.