The Benefits and Risks of Multiple Courses of Antenatal Corticosteroid Therapy in Patients with Preterm Premature Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes for women of singleton pregnancy with PPROM admitted at 24-32 weeks of gestation. Patients were categorized into 3 groups according to antenatal corticosteroids exposure: (1) non-user group, (2) single-course group, (3) multiple-course group. Chi-square test, analysis of variances, Kruskal-Wallis test, and multiple logistic regression analysis were used for statistical analyses. RESULTS: A total of 170 patients were included, with 50 in non-use group, 76 in single-course group, and 44 in multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred in the highest incidence in multiple-course group (x2=6.20, p<0.05) and the decreased incidence of RDS in multiple-course group (x2=10.0, p<0.01). Multiple logistic regression analyses demonstrated that no significant association was found after adjustment of confounding variables (odds ratio=0.28, p=0.063) whereas multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p=0.025). CONCLUSION: Multiple courses of antenatal corticosteroids therapy did not reduce the incidence of RDS in neonates and were associated with increased risk of clinical chorioamnionitis in patients with PPROM.

A Clinical Review of Acute Respiratory Distress Syndrome (ARDS) Due to Miliary Tuberculosis / 결핵

BACKGROUND: The detection and early elimination of the causes for acute respiratory distress syndrome (ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical findings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. METHODS: In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian Consensus Conference 1992. RESULTS: The mean age of the patients was 67+/-18 years (F:M=7:2). The chief complaints were dyspnea (5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean PaO2/FiO2 of the patients was 133.5+/-53.4, the number of cases with a WBC <5000/mm3 was 4 out of 9 cases. A platelet count <70,000/mm3 was observed in 2 out of 9 cases, and the serum albumin level was 2.6+/-0.6 g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. CONCLUSION: Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

Effect of propolis on the expression of CD54 and activation of NF-?B p65 of lung tissue in acute lung injury rats / 中国病理生理杂志

AIM: To study the effect of propolis on the expression of CD54 and activation of NF-?B p65 in lung tissue of acute lung injury (ALI) rats. METHODS: 40 male Wistar rats were divided into 5 groups: normal control, model control, dectancyl group, water soluble derivative of propolis (WSP) group and ethanol extracted propolis (EEP) group. ALI animal model was performed by oleic acid and LPS twice attack. The pathologic slice was observed with light microscope and the NF-?B p65 activity and CD54 expression were tested by immunohistochemistry (SABC and SP). RESULTS: Both EEP and WSP antagonized the lung edema, decreased the inflammation and inhibited the expression of CD54 and activation of NF-?B p65. CONCLUSION: The increase in the expression of CD54 and the activation of NF-?B p65 in the lung tissues of ALI were involved in the formation of ALI. Propolis ameliorated the lung damage, which maybe related to the inhibition of CD54 expression and NF-?B p65 activation.