Effect of Direct Breastfeeding Program for Premature Infants in Neonatal Intensive Care Unit

Purpose@#This study aimed to identify the effects of a direct breastfeeding program for premature infants in neonatal intensive care units (NICUs). @*Methods@#This quasi-experimental study was conducted during August 2016 to April 2017. Sixty mothers of premature infants were assigned to the experimental (n = 31) or control groups (n = 29). The program was comprised of breastfeeding education and direct breastfeeding support. The experimental and control groups were provided with education and counseling on breastfeeding at the time of admission and discharge. In the experimental group, the mothers initiated oral feeding with direct breastfeeding and engaged in breastfeeding at least seven times during the NICU stay. The collected data were analyzed by the χ2 -test and repeated measures ANOVA using an SPSS program. @*Results@#The experimental group showed a higher direct breastfeeding practice rate (χ2 = 19.29, p < .001), breastfeeding continuation rate (χ2 = 3.76, p < .001), and self-efficacy (F = 25.37, p < .001) than the control group except for maternal attachment. @*Conclusion@#The direct breastfeeding program in the NICU has significant effects on the practice and continuation rate of breastfeeding and breastfeeding self-efficacy. Therefore, this program can be applied in the NICU settings where direct breastfeeding is limited.

Comparison of two- and three-dimensional sonography for the prediction of the extrathyroidal extension of papillary thyroid carcinomas

BACKGROUND/AIMS: The purpose of this study was to compare the diagnostic validity of two-dimensional (2D) and three-dimensional (3D) ultrasonography (US) when predicting the extrathyroidal extension of papillary thyroid cancer. METHODS: All 2D data were interpreted in real time and 3D data were stored, rendered using tomographic ultrasound imaging (TUI), and then reviewed retrospectively. RESULTS: Extrathyroidal extension was present in 17 papillary thyroid cancers(24.3%) on pathology reports. The presence of contact was significantly associated with extrathyroidal extension on both 2D and 3D US (p = 0.007 and p = 0.003), and the sensitivity and specificity were not significantly different between 2D and 3D US (p = 1.000 and p = 0.754). The coexistence of protrusion and contact was not significantly associated with extrathyroidal extension on either 2D or 3D sonogram. CONCLUSIONS: Three-dimensional images rendered with TUI algorithms alone do not seem to be markedly superior to real-time 2D US in predicting the extrathyroidal extension of papillary thyroid cancer.

Adiposity in the Relationship between Serum Vitamin D Level and Insulin Resistance in Middle-Aged and Elderly Korean Adults: The Korea National Health and Nutrition Examination Survey 2008

BACKGROUND: The role of adiposity in the relationship between serum vitamin D levels and insulin resistance has not yet been fully studied. This aim of this study is to clarify the role of adiposity in the relationship between serum vitamin D level and insulin resistance among middle-aged and elderly Korean adults. METHODS: We used data from 2,710 individuals aged > or =50 years based on national data from a representative sample of the fourth Korea National Health and Nutrition Examination Survey IV-2 in 2008. RESULTS: After adjustment for potential confounders, body mass index (BMI) was significantly associated with 25(OH) vitamin D (P=0.008). However, waist circumference was not significantly associated with 25(OH) vitamin D. In the stratified analyses, 25(OH) vitamin D was found to be negatively associated with fasting insulin and homeostasis model assessment estimate of insulin resistance (HOMA-IR) in participants with BMIs > or =25 kg/m2 (P=0.003 for both insulin and HOMR-IR) but was not found to be associated in those with BMIs <23 kg/m2. However, we observed a significant inverse in the association of 25(OH) vitamin D with fasting insulin and HOMA-IR in both the normal (P=0.001 and P<0.001 and the abdominally obese group (P=0.010 and P=0.009) in the stratified analyses according to abdominal obesity. CONCLUSION: Our results support that the idea that endogenously-produced vitamin D might be stored in subcutaneous fat deposits. In addition, the association of vitamin D with insulin resistance in middle-aged and elderly Korean adults was stronger when it was stratified by BMI than when abdominal obesity status.

Thyrotoxic Periodic Paralysis Associated with Transient Thyrotoxicosis Due to Painless Thyroiditis

Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.

Predictive Factors for Incidental Contralateral Carcinoma in Patients with Unilateral Micropapillary Thyroid Carcinoma

BACKGROUND: Whether thyroid lobectomy alone is a sufficient treatment for papillary thyroid microcarcinoma (PTMC) remains controversial. The aim of this study is to evaluate the predictive factors for incidental contralateral carcinoma in patients confirmed of unilateral PTMC preoperatively. METHODS: Between January 2007 and December 2009, 393 patients underwent thyroid surgery for unifocal and unilateral PTMC preoperatively at Pusan National University Hospital. A total thyroidectomy with central neck dissection was routinely performed for these patients during this study period. RESULTS: Among the 393 cases in the cohort, 77 patients (19.6%) had incidental PTMC in the contralateral lobe. In patients with incidental contralateral carcinoma, there was higher prevalence in extrathyroid extension, occult ipsilateral carcinoma, pathologic Hashimoto's thyroiditis, and central lymph node metastasis compared to those without contralateral carcinoma. The mean tumor size also increased in patients with contralateral carcinoma. Multivariate logistic regression showed that extrathyroid extension (P = 0.049), occult ipsilateral carcinoma (P < 0.001), pathologic Hashimoto's thyroiditis (P = 0.038), and central lymph node metastasis (P = 0.002) were predictive factors for incidental contralateral carcinoma. CONCLUSION: In conclusion, multifocality in the ipsilateral lobe, central lymph node metastasis, extrathyroid extension, and Hashimoto's thyroiditis is associated with the presence of contralateral carcinoma. Thus, if these factors are found by preoperative and/or postoperative evaluation, total thyroidectomy or completion thyroidectomy is necessary for the treatment of PTMC.

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula

Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.

A Case of Bilateral Struma Ovarii Combined with Subclinical Hyperthyroidism

Struma ovarii is a rare monodermal variant of ovarian teratoma accounting for only 2% of all mature teratomas. To be classified as a struma ovarii, teratoma must be composed predominantly of mature thyroid tissue (> 50%). This tumor is generally benign, although malignant transformation has been reported. Struma ovarii occur mostly as unilateral cases, so bilateral cases are quite rare (less than 6% of cases). Struma ovarii occur largely without symptoms or are accompanied by non-specific symptoms, such as abdominal pain, a palpable abdominal mass, and abdominal distension. The preoperative diagnosis is generally difficult. The incidence of hyperthyroidism has been reported to be 5-10% of patients with struma ovarii. Thus, cases of functional bilateral struma ovarii are very rare. We report a case of bilateral struma ovarii with subclinical thyrotoxicosis and a diffuse goiter, mimicking a malignant ovarian tumor, and include a brief review of related literature.

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic resonance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.

A Case of Pediatric Solid Pseudopapillary Tumor of the Pancreas Treated with Gemcitabine / 임상소아혈액종양

Solid pseudopapillary tumors of the pancreas (SPTPs) are rare tumors with limited malignant potential; they are mainly diagnosed in young women. Complete surgical resection of the tumor is usually possible and patients have an excellent prognosis. However, local invasion and distant metastases have been reported in about 10-20% of patients with SPTPs; these patients require supplementary management for long-term survival. Here, we report a pediatric patient with inoperable SPTP unresponsive to neoadjuvant chemotherapy using cisplatin, ifosfamide, and etoposide which had spread to other organs. Subtotal resection of the primary tumor, radiofrequency ablation, radiotherapy, and adjuvant chemotherapy using gemcitabine were done to control this progressive SPTP.

Feasibility of Foley Catheter Prior to Endoscopy for the Removal of Esophageal Coin in Children / 대한소아소화기영양학회지

PURPOSE: This study evaluated the efficiency and safety of the Foley catheter for esophageal removal of coins in children, compared to standard endoscopic extraction with respect to success rate, sedation, promptness and cost. METHODS: Twenty four children with coin lodgement in esophagus were managed with either a Foley catheter (n=14) or endoscopic extraction (n=10) from January 2007 through August 2010 at Kyungpook National University Hospital. A retrospective review of medical records and radiological findings was performed. RESULTS: Of the 14 patients who underwent Foley catheter extraction, successful and complication-free removal was achieved in 10 cases (71.4%). Of the 10 patients who underwent endoscopic extraction, all cases were successful (p=0.114). Sedation rate in the Foley catheter and endoscopic extraction group was 6/14 and 10/10 (p=0.006). The average wait time before the procedure and average hospital charge (US$) were 2.0+/-1.1 hours and 18.1+/-13.7 hours, and $113 and $428 for Foley catheter extraction and endoscopic extraction, respectively. CONCLUSION: Foley catheter extraction may be tried for the removal of esophageal coins in uncomplicated children. The technique is effective, safe, inexpensive and free of general anesthesia.

A Case of Pediatric Solid Pseudopapillary Tumor of the Pancreas Treated with Gemcitabine / 임상소아혈액종양

Solid pseudopapillary tumors of the pancreas (SPTPs) are rare tumors with limited malignant potential; they are mainly diagnosed in young women. Complete surgical resection of the tumor is usually possible and patients have an excellent prognosis. However, local invasion and distant metastases have been reported in about 10-20% of patients with SPTPs; these patients require supplementary management for long-term survival. Here, we report a pediatric patient with inoperable SPTP unresponsive to neoadjuvant chemotherapy using cisplatin, ifosfamide, and etoposide which had spread to other organs. Subtotal resection of the primary tumor, radiofrequency ablation, radiotherapy, and adjuvant chemotherapy using gemcitabine were done to control this progressive SPTP.

Decreased Frequency of Aspiration Pneumonia after Percutaneous Endoscopic Gastrostomy in Neurodisabled Children with Dysphagia / 대한소아신경학회지

PURPOSE: Nasogastric tube or percutaneous endoscopic gastrostomy (PEG) tube can provide a means of feeding when oral intake is not adequate. This study aimed to evaluate the benefits of PEG such as reduced respiratory complications in neurodisabled children with dysphagia. METHODS: Twenty-six neurodisabled patients with dysphagia were followed-up after PEG for at least 12 months from 1999 to 2008. Medical records including characteristics, body weight, frequency of aspiration pneumonia, and grade of gastroesophageal reflux (GER) were reviewed retrospectively between the time before and after PEG. The data collected before PEG was compared with those at 0-6 months and 6-12 months after PEG. RESULTS: The 26 (male 14) enrolled patients had a mean age on PEG of 6.4+/-4.7 (0.9-16.9) years. The body weight percentile of 16 out of 26 patients was under the 3rd percentile. Underlying diseases were cerebral palsy (n=16), acquired brain-injury (n=4), spinal muscular atrophy (n=3), neurodegenerative disease (n=2), and congenital muscular dystrophy (n=1). Body weight was not significantly different before and after PEG. The frequency of aspiration pneumonia was 2.2 times per 6 months before PEG, compared to 0.35 times (0-6 months) and 0.27 times (6-12 months) after PEG, which showed a significant difference (P=0.000). CONCLUSION: The frequency of aspiration pneumonia decreased significantly by PEG in neurodisabled children with dysphagia.

Dual Fistulas of Ascending Aorta and Coronary Artery to Pulmonary Artery

Coronary artery fistula to pulmonary artery is common. However, to the best of our knowledge, a case of coronary artery fistula to pulmonary artery associated with aortopulmonary fistula remains unreported. We herein report a 64-year-old female with a left anterior descending coronary artery and ascending aorta to pulmonary artery fistulas, and conduct a brief review of the literature.

A Rare Case with Primary Undifferentiated Carcinoma of Pericardium

A primary pericardial tumor is very rare. A 77-year-old woman was admitted to our hospital with chief complaint of exertional dyspnea due to large amount of pericardial effusion. She was finally diagnosed as pericardial undifferentiated carcinoma without definite histopathologial, immunochemistry feature. Despite palliative radiation therapy, the patient died of multiple organ failure. The prognosis of primary pericardial undifferentiated carcinoma is known to be very poor, especially in old people.

LDL cholesterols levels after statin treatment: A comparison of measured vs. estimated values / 대한내과학회지

BACKGROUND/AIMS: Lowering low-density lipoprotein cholesterol (LDL-C) is the primary target for the prevention of cardiovascular disease. Previous studies have shown that estimated LDL-C levels calculated using Friedewald's formula (FLDL-C) are closely correlated with directly measured LDL-C levels (DLDL-C). However, because statins not only reduce LDL-C, but also alter the levels of parameters used to calculate FLDL-C (i.e., total cholesterol, triglycerides, and high-density lipoprotein cholesterol), whether calculated LDL-C levels remain a reliable estimate of actual levels after statin treatment is unclear. METHODS: Subjects included 985 patients at high risk of cardiovascular disease who had taken statins for more than 6 months. FLDL-C data were compared to DLDL-C data. RESULTS: A strong correlation was observed between DLDL-C and FLDL-C data (R2=0.879). However, the absolute values for FLDL-C and DLDL-C differed significantly according to a paired t-test, and 42.3% of patients showed a difference of greater than 10% between these two values. Among patients with diabetes, the percentage of patients deemed to have achieved target LDL-C levels differed significantly according to the method of LDL-C determination (p=0.007). CONCLUSIONS: FLDL-C and DLDL-C data remained well correlated after statin treatment, although the absolute values differed significantly according to the LDL-C determination method. Furthermore, the percentage of subjects deemed to achieve target LDL-C levels differed significantly according to the method of determination among patients with diabetes.

Effects of Drospirenone 2 mg with 17-beta-Estradiol 1 mg on blood pressure and body weight in postmenopausal Korean women / 대한산부인과학회지

OBJECTIVE: To evaluate effects of Drospirenone 2 mg (DRSP) with 17-beta-Estradiol 1 mg (E2) on blood pressure (BP) and body weight in postmenopausal Korean women. METHODS: BP and body weight were measured at baseline and 3 months of the treatment. We compared the change in BP and body weight between normotensive (group 1, control) and high-normotensive (group 2) group during treatment. And we compared the change in BP and body weight between hypertensive group receiving anti-hypertensive with (group 3) and without (group 4, control) DRSP/E2 during treatment. RESULTS: The mean systolic BP/diastolic BP of group 1 was not significantly decreased from baseline (116.9/75.0 mmHg) after treatment with DRSP/E2 for 3 months (116.1/73.2 mmHg) (P<0.152/P=0.088), however that of group 2 was significantly decreased from baseline (128.8/81.8 mmHg) after treatment with DRSP/E2 for 3 months (126.2/79.3 mmHg) (P<0.001/P=0.002). The mean systolic BP/diastolic BP of group 3 was significantly decreased from baseline (133.5/82.5 mmHg) after treatment with DRSP/E2 for 3 months (129.3/77.9 mmHg) (P<0.001/P<0.001), and that of group 4 was also significantly decreased from baseline (133.2/80.7 mmHg) after treatment with DRSP/E2 for 3 months (131.0/78.3 mmHg) (P=0.002/P<0.001). However change in the mean systolic BP/diastolic BP of group 3 was greater than that of group 4 (P=0.041/P=0.024). There was no weight change in all four groups. CONCLUSION: The use of DRSP/E2 showed a tendency to decrease the BP of high-normotensive or above in postmenopausal Korean women, and hypertensive patients receiving anti-hypertensive showed greater decline in BP. However there was no statistical significance in body weight change.

Assessing the Myocardial Function of Postmenopausal Women with Fibromyalgia / 대한류마티스학회지

BACKGROUND: Aberrations of cardiovascular regulation have been reported in patients who suffer with fibromyalgia (FM). Abnormalities of the cardiovascular autonomic regulation, as well as the correlation between coronary heart disease and depression, have been considered to be the causative factors. The clinical features of transient left apical ballooning syndrome with the patients under acute stress have been clearly described, but the effect of chronic stress such as FM on the myocardium is unknown. We investigated the cardiac strain in FM patients by strain imaging with using the 2D grayscale images, and we quantified the regional myocardial deformation properties. METHODS: We investigated 30 consecutive postmenopausal women (mean age: 48+/-8 years) who satisfied the criteria for fibromyalgia with atypical chest pain by performing standard and 2-dimensional strain echocardiography (2DS). Those patients with hypertension, coronary heart disease or diabetes were excluded. The global and segmental longitudinal deformation parameters of the LV from 3 apical views were analyzed, and the patients underwent a manual tender point survey for determining the number of tender points and tender point counts, and the patients completed the fibromyalgia impact questionnaire (FIQ), the brief fatigue inventory (BFI), and Beck depression inventory (BDI). RESULTS: The global longitudinal LV strain was significantly reduced in the FM patients with a high FIQ score (>40) as compared to the patients with a low FIQ score (-18.61% vs. -22.72%). Also, both the global and segmental longitudinal LV strains were negatively associated with fatigue or the tender point counts. However, there was no significant association between depression and the LV strain. CONCLUSION: This study showed the reduced myocardial longitudinal deformation in FM patients. This suggested that strain imaging is a feasible approach to assess the regional ventricular function in FM patients.

Apolipoprotein E polymorphisms in the development of hypertensive diseases of pregnancy in Korean women / 대한산부인과학회지

OBJECTIVE: Hypertensive disorder in pregnancy is one of the most serious obstetrical complications. Apolipoprotein E (Apo E) genotype is polymorphic and recently it was reported to be associated with preeclampsia. We undertook this study to clarify whether polymorphic marker of apolipoprotein E is associated with the development of hypertensive disorder in pregnancy. METHODS: Retrospective chart review was done. DNA was extracted from maternal blood of 124 healthy pregnant women and 253 women with hypertensive diseases in pregnancy. Hypertensive disorders complicating pregnancy include gestational hypertension (n=44), preeclampsia (n=158; mild=56, severe=102), preeclampsia superimposed preeclampsia (n=30), and chronic hypertension (n=21). Apo E allele was amplified by polymerase chain reaction, size fractionated on 4% agarose gels, and stained with ethidium bromide. RESULTS: We found all six possible genotypes of Apo E. However, three genotypes, E2/2, E2/4 and E4/4, were uncommon in Korean. We analysed the data according to each allele. Allele frequencies of the Apo epsilon2, epsilon3 and epsilon4 were as follows: 6.8%, 83.0%, 10.2% in women with gestational hypertension, 4.5%, 84.8%, 10.7% in women with mild preeclampsia, 5.9%, 85.3%, 8.8% in women with severe preeclampsia, 1.7%, 91.7%, 6.7% in women with superimposed preeclampsia, 0.0%, 90.5%, 9.5% in women with chronic hypertension, and 5.2%, 86.5%, 8.5% in normal controls. No significant difference in Apo E alllele frequency was found among these groups (P>0.05). CONCLUSIONS: The study suggests that specific allele of apolipoprotein E does not appear to be a risk factor for hypertensive disorders complicating pregnancy in Korean population.