A Case of Congenital Tuberculosis

Perinatal tuberculosis can be divided into congenital tuberculosis due to intrauterine infection and neonatal tuberculosis due to infection irnmediately following birth. It is a rare disease entity with only 300 cases reported worldwide. In Korea, only a few cases have been reported and only 1 case has been confirmed by autopsy at neonatal period. Although the majority of the mothers are found to have advanced tuberculosis and the children themselves are usually of premature birth, early diagnosis is difficult and despite antituberculous medication, the mortality rate is high. We report a premature baby with respiratory difficulty admitted to our hospital, whose mother was found to have miliary tuberculosis during the course of management. The baby died and autopsy was performed to confirm congenital tuberculosis.

Effects of Hydrogen Peroxide and Catalase on Physical Properties of Surfactant

PURPOSE: In the treatrnent of respiratory distress syndrome, Infants are often exposed to hyperoxia. It can generate oxygen free radical, damage to lung and bronchi, and inactivate pulmonary surfactant(PS). Antioxidant therapy in animal and human models has been tried to overcome this detrimental effects. We hypothesized that the addition of oxygen free radical such as hydrogen peroxide(H) could compromise surface active properties(SAP) of PS and that further addition of antioxidant such as catalaseR(CAT, Sigma chemical, St. Louis) could recover SAP. METHODS: We prepared combinations of mixtures with SurfactenR(S-TA, Tokyo Tanabe, Japan), H202 and CAT. 1)0.625mgPL(phospholipids)/ml or 1.25mgPL/ml S - TA and H202 were mixed to the final concentrations of 0.1 and 1mM H respectively, and incubated at 37C for one hour. 2) 0.625mgPL/rnl S - TA, H202 and CAT 10U were mixed to the final concentrations of lmM H202, and incubated at 37 degree C for one hour. We used Pulsating Bubble Surfactometer (Electronetics, NY) measure in vitro minimum and maximum surface tensions(ST) and area-surface tension relationship. RESULTS: 1) For 0.625mgPL/ml S-TA and 1mM H mixture minimum. ST after 5 min of pulsation increased significantly(P=0.007) and the area-surface tension curve was deformed. But they were comparable to control levels for 1.25mgPL/ml S-TA. 2) When CAT was added to 0.625mgPL/ml S-TA and 1mM H mixture, the resultant minimum ST after 5 min of pulsation dropped to the control levels with recovery of hysteresis curve(P=0.0001). CONCLUSION: PS could be inactivated by addition of high concentrations of H but SAP can be recovered either by increasing PS concentration or by further addition of antioxidant CAT. Therefore, we suggest that in case of suspected surfactant inactivation an increase in surfactant concentration or administration of antioxidant must be considered.

Risk Factors of Paternt Ductus Arteriosus in Very Low Birth Weight infants

PURPOSE: Hemodynamically significant patent ductus arteriosus (PDA) may increase the mortality of premature infants who received ventilator care by aggravating hypoxia, acidosis, pulmonary edema and hypotension. The risk factors for PDA in premature infants are low gestational age, infusion of excessive fluid, and severity of neonatal respiratory distress syndrome. We studied the risk factors of PDA in very low birth weight infants (VLBW) to establish a guideline for the treatment. METHODS: VLBW infants who were born at Severance Hospital, Yonsei Medical Center from January, 1989 through December, 1995 and survived for at least 5 days with ventilator care were recruited for this study. Patent ductus arteriosus was diagnosed according to the clinical diagnostic criteria of Yeh (Yeh et al, 1981b). Thirty six infants had diagnosed as PDA (PDA group), and thirty seven infants who had not PDA were selected as control. Both groups of infants received restrictive fluid therapy. RESULTS: 1) Gestational age, sex, Apgar score, administration of surfactant, mode of delivery, toxemia and use of antenatal dexamethasone were similar between PDA and control infants. 2) In PDA group, ventilatory index and duration of vetilator care were significantly greater (P<0.05), and a/ApO2 was significantly lower than control group (P<0.05). There was no difference in peak inspiratory pressure at initial setting, the highest peak inspiratory pressure and mean airway pressure during ventilator care. 3) During the first 3 days of life, the urine output was similar between groups. On the 4th and 5th days of life, PDA group had significantly reduced urine ouput compared with control (on day 4; 2.6+/-1.1 ml/kg/h vs. 3.2+/-1.2ml/kg/h, P<0.05; on day 5, 2.9+/-1.4ml/kg/h vs. 3.6+/-1.6ml/kg/h, P<0.05) . 4) The percent weight loss compared to birth weight was siginificantly lower in PDA group (12.5% vs. 15.1%, P<0.05). 5) The PDA group had higher incidences of bronchpulmonary dysplasia and intraventricular hemorrhage (P<0.05). CONCLUSION: Among Vlnfants who received restrictive fluid therapy during the first 5 days of life, infants with PDA had reduced urine output and percent weight loss than control group.

Clinical Studies on Enteropathogenic E.Coli Enteritis in a Newborn Nursery

No abstract available.

Tuberculous Abscess and Empyema of the Liver

We have experienced a case of tuberculous abscess of the liver with empyema in a 12 years old boy. He was admitted with the chief complaints of pain and mass in the right upper abdomen of about 1 month duration and intermittent mild fever for 15 days. On examination, liver was palpable 5 cm below the right costal margin, and was tender and firm. Liver scan showed a cold area in the right posterior upper part of the liver. With the needle aspiration of the liver, 240 ml of yellowish-green pus was aspirated. The stained smears of the pus showed a large number of acid-fast bacilli, and the culture revealed a growth of Mycobacterium tuberculosis. Our patient was cured successfully by the drainage of pus with the needle aspiration of the liver and antituberculous medication. We have presented here a rare case whose the diagnosis was made without the help of any operative procedure, and reviewed the literatures.