Effect of Positive End Expiratory Pressure on Intra-abdominal Pressure and Abdominal Perfusion Pressure at an Increased Intra-abdominal Pressure / 대한마취과학회지

BACKGROUND: Increased intra-abdominal pressure (IAP) leads to adverse effects on most organ systems and is associated with significant morbidity and mortality in surgical and trauma patients. The purpose of this study was to determine the effect of positive end expiratory pressure (PEEP) on IAP and abdominal perfusion pressure (APP, mean arterial pressure, MAP minus IAP) at normal and increased intra-abdominal pressures. METHODS: 15 patients requiring a laparoscopic cholecystectomy were included. IAP was measured indirectly using a transurethral catheter, and APP was calculated for each patient at 0, 5, 10, 15, and 20 cmH2O of PEEP, while the insufflator pressure was maintained at either 0 or 15 mmHg. RESULTS: At each insufflator pressure, IAP increased with higher PEEP levels (P < 0.05). At 0 mmHg insufflator pressure state, MAP substantially decreased according to increasing PEEP levels, however, at 15 mmHg insufflator pressure state, MAP substantially increased despite increasing PEEP levels. Meanwhile, APP decreased with increasing PEEP levels at an insufflator pressure of zero while remaining constant at a 15 mmHg insufflator pressure. CONCLUSIONS: We found that IAP increases in response to higher PEEP levels (10, 15, and 20 cmH2O) at insufflator pressures of both zero and 15 mmHg in patients anesthetized for laparoscopic cholecystectomy. However, APP did not decrease with increasing PEEP levels at a higher intraadominal pressure (15 mmHg).

Thyroid Dysfunction in Premature Infants

PURPOSE: Severe neonatal hypothyroxinemia is associated with leukomalacia, intraventicular hemorrhage and long-term neurodevelopmental disability. We designed this study to evaluate the incidence of thyroid dysfunctions and the effects of low T4 level on neonatal morbidity to establish the basis for the thyroid hormone supplementation. METHODS: Thyroid function tests, measured by radioimmunoassay and filter paper screening, were obtained from the preterm infants with birth weights less than 2000 g. The first measurement was done during 2nd week of life followed by the measurement at 2 weeks later and repeated until normalized. RESULTS: 17/32 (53.1%) infants had thyroid dysfunction: Four infants had hypothyroidism, twelve infants had hypothyroxinemia and one infant had hyperthyrotropinemia. The frequency of thyroid dysfunction showed inverse relationship to the birth weight. All infants with birth weights less than 1, 000 g, 11 infants (70.6%) with birth weights between 1, 000 and 1, 499 g and two infants (18.2%) with birth weights more than 1500 g had thyroid dysfunction. Nine infants with thyroid dysfunction were not detected by filter paper screening test. Infants with hypothyroxinemia had more RDS, longer mechanical ventilation days and hospital stay compared to the infants with normal T4 level. CONCLUSION: Thyroid dysfunction is frequently observed in premature infants and it can be associated with increased neonatal morbidity. Serial follow up of thyroid function test is recommened among premature infants.

A Histological and Clinical Study of the Children with Thin Glomerular Basement Membrane

PURPOSE: Thin glomerular basement membrane disease(TGBMD) is found in patients with family history of hematuria. TGBMD is autosomal dominant and is known to be one of the commonest causes of asymptomatic hematuria. This study was conducted to evaluate the histological and clinical features of patients with TGBMD. METHODS: 150 cases diagnosed with TGBMD by renal biopsy while admitted in the department of pediatrics, Kyungpook National University Hospital between January 1999 and December 2003 comprised the study group. The following parameters were retrospectively analyzed:age of onset, hematuria pattern, existence of proteinuria, process of diagnosis, laboratory findings, thickness and character of basement membrane and family history. RESULTS: The mean age at the time of diagnosis was 7.9 years. The male to female ratio was 65:77. 94 patients or 66% visited the hospital with a chief complaint of persistent microscopic hematuria. Gross hematuria accounted for 13 cases or 9%. 78 cases(55%) were found to have hematuria for the first time from a routine school urinalysis screening. The renal biopsy showed the thickness of basement membrane to be 186+/-36 nm. Focal lamellation of the basement membrane was found in eight cases. In the family history, hematuria was shown in 10 cases on the paternal side, 13 on the maternal side and none on both sides. In seven cases, hematuria was shown among siblings. No significant differences were found among the laboratory test results which were conducted at an average interval of fifteen months. CONCLUSION: TGBMD is one of the major causes of asymptomatic hematuria in children, which was diagnosed in increasing numbers since school urinary mass screening test started in 1998. In cases with familial progressive renal disease or focal duplication in the basement membrane Alport syndrome should be considered.

Postprandial Hepatic Volume Change: Spiral CT Evaluation in Case of Liver Cirrhosis

PURPOSE: To investigate the usefulness of evaluating liver cirrhosis through the measurement of liver volume. MATERIALS AND METHODS: In a control group(20 normal subjects) and 20 cirrhotic patients, variations in liver volume before and after a meal were obtained. A case-control study was conducted between the two groups. RESULTS: In the control group, the range of increased liver volume after the meal was 67-186ml. Mean increased liver volume was 119.3ml, the range of percentage increase was 6-12% and the mean percentage increase was 9.89%. In cirrhotic patients, the range of increased liver volume after the meal was 1-20ml. Mean increased liver volume was 6.9ml, the range of percentage increase was 0-1.9% and the mean percentage increase was 0.65%. Compared with the control group, cirrhotic patients showed a much smaller increase in liver volume (p<0.01). CONCLUSION: Difference in variation of liver volume between a control group and cirrhotic patients before and after a meal can be used for the evaluation of liver cirrhosis.